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HEART Adoption Questionnaire
All HEART animals have been stray, abandoned or abused and are in need of loving, forever homes. In order to ensure our cats and dogs have the best future possible, we ask you to kindly fill out this questionnaire.
Email *
Full name *
Age *
Home address *
Email address *
Telephone *
Why did you decide to adopt an animal from HEART? *
I want to adopt an animal for *
If you are adopting an animal for your children please explain the reason why
How many people do you live with? *
Are there children living in your home? *
If there are children, how many and what age are they?
Do all members of your family agree to adopt a new pet? *
Who will be mainly responsible for the care of your new pet? *
Does any one in your family plan to have a baby in the near future? *
Is anyone in your family allergic to cats or dogs? *
I live in a *
My home is *
If you rent, does the housing contract allow pets? *
Would it be possible for us to obtain a copy of your housing contract? *
How long have you been in your current home? *
Do you plan to move in the near future? *
If you move, what do you plan to do with your pet?
Do you have any other pets? *
If yes, please tell us a little more about your pet(s). We want to know the type of animal, its age, how long you have had it, whether it is neutered, and where you got it.
Have you ever had a pet before? *
If yes, please tell us a little more about your former pet(s). We want to know the type of animal, its age, how long you have had it, whether it was neutered, where you got it, and why it is no longer with you.
If you work outside the home, how long will your pet be left alone? *
When you go on vacation or outings, what will you do with your pet? *
Do you have a veterinarian? *
If yes, please tell us a little more about your veterinarian. We want to know the name of the clinic, their address, and their telephone number.
Are you aware of and willing to pay for vaccines and other preventative medications for your pet? *
Are you willing and able to provide veterinarian care for you pet if he/she becomes ill? *
Where will you keep your new pet? *
What is your residency status in Japan? *
Is there a possibility of relocating to another country in the future? *
Required
If yes, which country? and are you aware of animal import and export regulations?
Will you allow members of HEART to come to your home and/or contact you to check on the animal? *
Are you interested in adopting a cat or dog? and/or is there a particular animal(s) on the HEART homepage you are applying for? *
Other comments or questions
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