Adoption Application

H.E.A.R.T.

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NOTE: If you do NOT receive an email from HEART within 12-hours of submitting this form, that means we did not receive this. Our web provider is having issues with form submissions, so we have added this Google form below to use in the interim which we hope solves the problem. We appreciate your patience with this, so if you do not hear back from us, please email heartrescue2016@gmail.com or send us a message on our Facebook page.

App you can print off and email below

heart_application_form.pdf
File Size:	103 kb
File Type:	pdf

Download File

Application for Adoption from H.E.A.R.T.
Please fill out this as thoroughly as possible and submit electronically or you may choose to print and email or mail this application from above link. We will get back to confirm receipt to you no later than 12 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!
*If you prefer to print off application to scan and email or mail to HEART, the pdf file is at top of page. Please note that we will not get this as soon as online submitted apps, you can also let us know that you are sending. Thank you!

* Indicates required field

Email *

Pet you are applying for *

Cat Dog Other

Name(s) of the animals *

Your Name *MUST be your legal name *

First

Last

Please make sure you provide your current legal name.

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 and birthdates of all over 18 living in the household including yourself. *

Please note we will do background checks on all people 18 and over living in the household.

Do you live in: *

Apartment Condominium House Other

Do you rent or own? *

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

We will verify home ownership.

Do you have a fenced-in yard? *

Yes No

If renting, name and phone number of landlord. Please note, we will verify with landlord before adopting any pets (or N/A) *

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? If none, put N/A. *

Do you current pets live: *

Indoors Outdoors No current pets

Are your pets spayed and/or neutered? *

Yes No *Explain below No current pets

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

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

Yes No *Explain below

If you answered "No" to current vaccinations, please explain below, or N/A *

Veterinarian's name & phone number *Some clinics require your permission to release info to us, so let your vet know we will be contacting them. *

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

If applicable, groomer's name & phone or N/A *

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. *

For prior pets: (Mark all applicable) *

They were spayed/neutered They were kept up to date on distemper and rabies vaccines Please explain below if either of the above are not checked

1st personal reference name & phone number *

Reference not related to you by birth, marriage, partnership

2nd personal reference name & 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 Not adopting a cat 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. *

Disclosure: 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 HEART will do a background check on anyone over 18 years old, and if any criminal record appears the application may be denied immediately. You also understand that HEART reserves the right to request a home visit prior to adoption approval. *If you have not entered info in all "required" boxes, you will need to correct or your application will not submit. *

***Check the box below if you have read/understand all information above. *

I have read & understand the disclosure above. Any additional explanations I have included on my application.

Submit

App you can print off and email below

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