Support NHS

1.

Applicant information

*

Name:

First Required	Last Required

*

Email: Required

*

Street 1: Required

Street 2:

*

City/State/ZIP:

City Required	State Required	ZIP Required

*

Phone Number: Required

*

Date of Birth: Required

Date of Birth:

If you respond and have not already registered, you will receive periodic updates and communications from Nebraska Humane Society.

Yes, I would like to receive postal mail from Nebraska Humane Society

Keep me logged in. What's this?

*2.

Question - Required - Is this the first application you have submitted for this type of animal in 2020?

*3.

Question - Required - Do you own or rent your home? If you rent or are not the owner of the home, please list the owner or landlord's contact information and the name of the apartment complex

(Maximum response 255 chars, approx. 5 rows of text)

*4.

Question - Required - Does your home have a fenced in yard? If so, what type of fence and how high is it?

(Maximum response 255 chars, approx. 5 rows of text)

*5.

Question - Required - How many adults live in your home?

(Maximum response 255 chars, approx. 5 rows of text)

*6.

Question - Required - List the ages of any children with which the animal will have regular contact. How frequently will they be in contact?

(Maximum response 255 chars, approx. 5 rows of text)

*7.

Question - Required - On an average day, how many hours at a time will the animal be left alone?

(Maximum response 255 chars, approx. 5 rows of text)

*8.

Question - Required - Please list any cats, dogs, or other animals in the household. Include the type/breed of animal, age, sex, and whether or not they are spayed or neutered.

(Maximum response 255 chars, approx. 5 rows of text)

*9.

Question - Required - Have you owned dogs in the past? If so, tell us about with what kinds of dogs (breed, size, age, etc.) you have experience.

(Maximum response 255 chars, approx. 5 rows of text)

*10.

Question - Required - Why are you looking to add a new dog to your household?

(Maximum response 255 chars, approx. 5 rows of text)

*11.

Question - Required - List up to three dogs with which you are interested. Please include their identification numbers.

(Maximum response 255 chars, approx. 5 rows of text)

*12.

How did you hear about this animal?

(Select one of the available choices or enter a different value.)
Question - Required -

If the dog or dogs in which you are interested have been adopted or have restrictions that your home does not meet, we will try to match you with a dog instead. The following information will help us find a dog that meets what you are looking for.

*13.

Question - Required - Provide the age range for the dog that you are searching for.

(Maximum response 255 chars, approx. 5 rows of text)

*14.

Do you have a preference in gender?

(Select one of the available choices or enter a different value.)
Question - Required -

*15.

Question - Required - Are you particular about the breed or size of dog? For example, if you are not interested in any pittie mixes, or would only like a small dog, please indicate so.

(Maximum response 255 chars, approx. 5 rows of text)

*16.

Question - Required - Are you comfortable with dogs with longer fur or higher grooming needs or are you only interested in short-coated dogs?

(Maximum response 255 chars, approx. 5 rows of text)

*17.

Question - Required - Describe the energy level of your ideal dog. If you want a dog to take on long runs every other day, or if you're more into short walks a couple of times a week, let us know!

(Maximum response 255 chars, approx. 5 rows of text)

*18.

Question - Required - Describe how much training you are comfortable doing with your dog. If you are comfortable handling unruly dogs or dogs that might need a lot of training, let us know!

(Maximum response 255 chars, approx. 5 rows of text)

Foster dog adoption application