Adoption Application

H.E.A.R.T. of IA, MN, & WI

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Application for Adoption from H.E.A.R.T.
Please fill out this as thoroughly as possibly and submit electronically or you may choose to print and email or mail this application. We will get back to you no later than 48 hours after you submit or we receive your application by mail. If you do not hear back from us, (since sometimes internet and mail get sidetracked) please email heartrescue2016@gmail.com. THANK YOU!

* Indicates required field

Email *

Pet you are applying for *

Cat Dog Other

Name(s) of the animals *

Your Name *

First

Last

Your Street Address *

Your City *

Your State *

Your Zip Code *

Home Phone Number *

Cell Phone Number *

Employer *

Number of children in household *

Age(s) of children in household or N/A *

Full names/birthdates of all over 18 living in the household including yourself. *

Do you live in: *

Apartment Condominium House Other

Do you rent or own? *

Rent Own Other (please explain in additional comment section at end

Do you have a fenced-in yard? *

Yes No I plan to fence my yard

If renting, name and phone number of landlord. Please note, we will verify with landlord before adopting any pets *

Current pets in your household *

Cat(s) Dog(s) Other No current pets

If yes to pets currently in household, what are the names/breeds/ages/sex? *

Do you current pets live: *

Indoors Outdoors

Are your pets spayed and/or neutered? *

Yes No

If you answer "No" to question above on spay/neuter and have specific reasons, please explain *

Are all your current pets up to date on vaccinations? *

Yes No *Explain below

If you answered "No" to current vaccinations, please explain below. *

Veterinarian's name/phone number *

Please note by submitting application, we will verify information with your vet

If applicable, groomer's name & phone *

Please list any animals (other than current pets listed above) that you have had in the last 5 years. Put their names and the vet you had for them. *

Additional reference/phone number *

Reference not related to you by birth, marriage, partnership

Additional reference/phone number *

What experience do you have raising a pet? *

Why do you want to adopt this dog or cat? *

Will this be an indoor or outdoor pet? *

Indoor Outdoor Indoor & Outdoor, explain in add'l comments

If adopting a cat, do you plan on declawing him/her? *

Yes No Not sure I would like more info about this

What type of facilities do you have to accommodate a pet while you are gone? *

What type of exercise will you give him/her? *

On an average day, how many hours will your pet be home alone? *

Have you ever given up a pet & what was the reason? *

What reason(s) would you ever give up a pet? *

Does anyone in your family have known allergies to animals? *

Yes No

How would you describe your household? *

Quiet Lively Active Average

Anything else we should know in regards to considering your application? You may also give further explanations for any answers you feel need further information. *

By entering your name here, you attest that all information on this form is accurate to the best of your knowledge. You also understand that H.E.A.R.T. will verify the information you give and may also do public records check. *

Submit

Home
About Us
- HEART Bylaws
- Member Info
Adopt
- Adoption Application
- Adoption Contract
Foster
- Foster home application
- FOSTER-INTAKE ASSESSMENT
Donations
- Amazon donations
- Links for Supporters
Surrender
- Surrender Form
- Courtesy Listing
Happy FUR-EVER Tails!
- Jan-April 2018
- May 2018
Contact

© 2016 H.E.A.R.T. Helping every Animal Rescue Team