HEART Adoption Application
Please understand that we do not adopt on a first come-first serve basis. Pre-approved applicants do not need to re-apply, just contact us if you see an animal you feel would be a good fit and your application will be considered with any others. We work very hard to choose the home that is best suited to the animal and family alike. We require that all animals in your home are spayed/neutered and up to date on vaccines (exceptions may be made for health related decisions made and confirmed by a licensed veterinarian). Please complete ALL questions on this form. Some may not pertain to you, so a N/A is appropriate (form will not submit if all questions are not completed.) A HEART volunteer will confirm receipt of this submission within 24 hours by email, so if you do not receive confirmation, please contact us by email at heartrescue2016@gmail.com or send us a message on our Facebook page. Please also feel free to email us if you have any questions prior to filling out this form. If you are not applying for a specific animal and just looking to be pre-approved, note that on "name of animal" line. Pre-approval does not always mean you would be the best fit for all animals.
Name(s) of Animal Applying for today *
Your Full Legal Name *
Physical Address (*No PO Boxes) *
City, State, Zip Code *
Home Phone *
Email *
Cell Phone *
Full Legal Names & Birthdates of all over 18 living in the household including yourself. *
Are children living in the home? (Under 18 years old) *
If yes to the question above, what are their ages? (Or N/A) *
Are there other children who are frequently in the home such as grandchildren/relatives, daycare, etc.? *
Your current employer and # of years with them. *
Spouse's/Partner's current employer and # of years with them. N/A if no spouse/partner. *
Home ownership/residence? (We must be able to verify) *
If renting, what is the name and phone number for your landlord? (Approval is required) If not renting, put N/A. *
Do you have a fenced in yard/area? Though not a requirement for all dogs, but HEART may suggest specific dogs be in a home with a fence. *
Describe your fenced yard/area (ex: how high, material, attached/not attached to house, doggy door, condition of area). *
Current Pets: List all pets currently in the household, including all dogs/cats living outdoors. You can list "farm cats" as one. *List breed, name, age, sex. If none, put NA. We will verify information with your vet. *
Do current pets live: *
Are current pets spayed/neutered? *
Are current pets kept up to date on vaccinations? *
Vet clinic Name AND Phone number. *NOTE: Some clinics require you to give permission for us to verify information so contact them to let them know. *
Please describe how your current pet(s) get along with other animals including ones they do not know. If approved, meet and greets with resident animals will be recommended. If no current pets, put N/A. *
Groomer's name/phone if applicable or NA *
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 N/A. *
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. Please let them know HEART may be calling. *
2nd Personal Reference Name & Phone who is non-related. Please let them know HEART may be calling. *
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. *
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. *
Have you ever given up a pet, and if so, what was the reason(s). *
What would be reason(s) you would ever give up a pet? Include info as to reasons you would return the animal to HEART in the first 2 weeks. *
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. *
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. *
*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
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.