Adoption Application

First Name *

Last Name *

Email Address *

Street Address *

City *

State *

Use state abbreviation

Zip Code *

Phone Number *

No dashes, just digits.

What is the best way to reach you?

Phone

Other:

Clear selection

Please list specific dogs from our website that you are interested in. *

What age of dog are you looking for? (select all that apply) *

Puppy (<1 year)

Adolescent (1-3 years)

Adult (3-9 years)

Senior (9+ years)

Required

Would you consider adopting a mixed breed Australian Cattle Dog? *

Yes

What gender would you prefer? *

Female

Male

No preference

On average, how long will your new dog be left alone each day? *

Please check any following special needs you would consider adopting. *

Deaf

Blind

Incontinent

Fearful

Dog/Cat/Small animal aggressive

Needs medications

Ongoing medical care needed

None of these

Required

Why do you want a cattle dog? *

Working dog

Adult/child companion

Pet companion

Agility

Tracking

Other:

Required

How many adults live in the home? *

How many children live in the home? *

Ages of children?

What is your family's activity level? *

How many pets do you have? *

Age(s)

Breed/Species

Gender(s)

Are all of your pets spayed/neutered?

Yes

Clear selection

All dogs and cats in the home must be spayed/neutered prior to adoption. Unless for medical reasons the dog or cat can’t be spayed Heeling Heelers Hearts will need to see documentation from a licensed veterinarian.

Are all of your pets current on their vaccinations?

Yes

Clear selection

Please explain why your pets are not current on their vaccinations.

Have you ever had to relinquish a pet (take to pound, give to friends,etc.)? *

Yes

Please explain why you had to relinquish a pet.

Have you ever owned a Cattle Dog or mixed breed Cattle Dog? *

Yes

Please tell us your experience with the breed.

What type of home do you reside in? *

Apartment/condo/town home

Single-family

Other:

Do you own your home? *

Yes

If you do not own your own home, can you provide us with a letter from your landlord granting permission to own a dog prior to adoption?

Yes

Clear selection

Is the backyard completely enclosed? *

Yes

What type of fence do you have?

Block

Chain

Wood

Laminate

Other:

Clear selection

Do you have a pool? *

Yes

Is the pool fenced?

Yes

Clear selection

Where will your new dog be kept while you are away? (check all the apply) *

Inside only - free run of the house

Inside only - confined (kennel, small room)

Inside/outside (dog door access)

Outside only

Other:

Required

Where will your new dog sleep? (check all the apply) *

Inside only - free run of the house

Inside only - confined (kennel, small room)

Inside/outside (dog door access)

Other:

Required

We will not adopt to anyone that is going to keep their dog outside 24/7.

How will your new dog be transported in a vehicle? (check all that apply) *

Free in backseat

Seatbelted

Crated

Bed of trunk with camper shell

Other:

Required

What would you do with your new dog in the case of a life altering event? This includes things like relocation, loss of employment, needing to provide hospice care for the dog, or development of dog allergies by a family member? *

What would you do in the case of an incident involving your dog? This includes things like the dog developing destructive behaviors, getting in a dog fight, biting someone, or barking excessively. *

Please provide the name and phone number of three personal references (that do not live with you) that we may contact.

Reference 1 *

Reference 2 *

Reference 3 *

We thank you for your interest in adopting one of our dogs. Our adoption coordinator will contact you within two business days to discuss your application and further steps.

Submit

Never submit passwords through Google Forms.

Forms

This content is neither created nor endorsed by Google.