HEART Adoption Application
Please complete this form and submit. A HEART volunteer will confirm receipt of this submission with 12 hours by email, so if you do not receive confirmation, please contact us by email at heartrescueteam2016@gmail.com or send us a Facebook message on our page. Please also feel free to email us if you have any questions prior to filling out this form.
Your Legal Name *
Your answer
Email *
Your answer
Street Address *
Your answer
City, State, Zip Code *
Your answer
Name(s) of Animals Applying for today *
Your answer
Why do you want to adopt this pet AND what experience do you have raising a pet. *
Your answer
Home Phone *
Your answer
Cell Phone *
Your answer
Employer *
Your answer
Full Legal Names & Birthdates of all over 18 living in the household including yourself. *
Your answer
Ages of children in the household *
Your answer
Do you live in: *
Do you Rent or Own? *
If renting, name and phone number of landlord. Note: we will verify with landlord on pet rules.
Your answer
Do you have a fenced-in yard? *
Current Pets: List all pets currently in the household, including all domestic pets living outdoors. *List breed, name, age, sex. If none, put NA. We will verify information with your vet. *
Your answer
Do current pets live: *
Are current pets spayed/neutered? *
Are current pets kept up to date on vaccinations? *
Vet clinic Name/Phone number. *NOTE: Some clinics require you to give permission for us to verify information so contact them to let them know. *
Your answer
Groomer's name/phone if applicable or NA *
Your answer
Please list any pet (other than current pets) you have had in the last 5 years. List name and vet if different from current vet. If none, put NA. *
Your answer
For prior pets listed in question above: If BOTH boxes are not checked, please explain specific reason in additional comments. *
Required
1st Personal Reference Name & Phone *
Your answer
2nd Personal Reference Name & Phone (Non-related) *
Your answer
Will pet applying for be: *
If adopting a cat, do you plan on declawing? *
What types of facilities do you have to accommodate a pet while you are gone. *
Your answer
On an average day, how many hours will you pet be home alone? Also can comment if they will be checked on by you/others during absence. *
Your answer
Have you ever given up a pet, and if so, what was the reason(s). *
Your answer
What would be reason(s) you would ever give up a pet? *
Your answer
Does anyone in your family have known allergies to animals? *
How would you describe your household? *
Anything else we should know in regards to considering your application? Please also give further explanations to any questions above that may need further explanations. *
Your answer
DISCLOSURE: By entering your NAME/DATE below, 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. *
Your answer
*Check the box if you have read & understand the disclosure above. You have also added any additional explanations that are needed from any question. *
Required
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