Adoption Application

H.E.A.R.T.

heart_application_form.pdf
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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 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!
***NOTE: If successfully submitted, you will get a message after you submit.
If you have trouble submitting:
1. PLEASE check that you have entered info in all boxes. If not applicable, you can put N/A.
2 You may need to clear your cache and/or cookies on phone/computer. (browser can tend to hold onto info, so good idea to clear these on regular basis anyway.
3. Try another web browser.
*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

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. *

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

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. *

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 *

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

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

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