Your Full Name (First and Last)*

Your Email*

Your Phone Number*

Cell or Work Phone Number

Your Address (Please include City and Zip Code)*

Do you own or rent?*

Number of people in your home?*

Number of children in your home? (Please include ages)

If no children living in your home, do children visit frequently? (grandchildren, friend's children, etc)

Do you have an active/busy home (lots of coming and going, frequent visitors) or is your home quiet and calm, without frequent visitors?*

Do you have a fenced-in yard?*

Type of fence? Height?

Will pet live inside, outside, or both?*

Will pet need to use the stairs?*

Is there a specific dog that interests you? What are you looking for in a dog?*

Are you open to adopting a dog that doesn't get along with other dogs?*

Please list your current pets with a description and age of each.*

Please list pets you have previously had, and why they are no longer with you.

Name and phone number of your current veterinarian?*

Name and phone number of previous veterinarian(s)?*

What do you do for a living?*

How do you correct unwanted behaviors in a pet? Please give an example.*

How did you find out about Hallie Hill?*

I declare that the above is true to the best of my knowledge and ability. By submitting this application, I authorize the veterinarian listed to release any medical information of my current or previous pets. I also read the note displayed above this application.