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.
* Required
Name(s) of Animal Applying for today
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Your answer
Your Full Legal Name
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Your answer
Physical Address (*No PO Boxes)
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Your answer
City, State, Zip Code
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Your answer
Home Phone
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Your answer
Email
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Your answer
Cell Phone
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Your answer
Full Legal Names & Birthdates of all over 18 living in the household including yourself.
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Your answer
Are children living in the home? (Under 18 years old)
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Yes
No
If yes to the question above, what are their ages? (Or N/A)
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Your answer
Are there other children who are frequently in the home such as grandchildren/relatives, daycare, etc.?
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Yes *Please explain in comment section
No
Your current employer and # of years with them.
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Your answer
Spouse's/Partner's current employer and # of years with them. N/A if no spouse/partner.
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Your answer
Home ownership/residence? (We must be able to verify)
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Own (put N/A on next question if this is marked)
Rent * Must complete next question
Other *Explain this option in the additional comment section
If renting, what is the name and phone number for your landlord? (Approval is required) If not renting, put N/A.
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Your answer
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.
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Yes
No
Describe your fenced yard/area (ex: how high, material, attached/not attached to house, doggy door, condition of area).
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Your answer
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.
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Your answer
Do current pets live:
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Inside
Outside
No current pets
Are current pets spayed/neutered?
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Yes
No *Explain specific reasons for this answer in additional comments
No current pets
Are current pets kept up to date on vaccinations?
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Yes
No *Explain specific reasons for this answer in additional comments
No current pets
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.
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Your answer
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.
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Your answer
Groomer's name/phone if applicable or NA
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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 N/A.
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Your answer
For prior pets listed in question above: If BOTH boxes are not checked, please explain specific reason in additional comments.
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They were spayed/neutered
They were kept up to date on distemper and rabies vaccines
No prior pets
Required
1st Personal Reference Name & Phone. Please let them know HEART may be calling.
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Your answer
2nd Personal Reference Name & Phone who is non-related. Please let them know HEART may be calling.
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Your answer
Will pet applying for be:
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Indoor pet
Outdoor pet
Indoor & Outdoor *Explain this answer in additional comments
If adopting a cat, do you plan on declawing?
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Yes
No
Not sure, would like more information on this
Not adopting a cat
What types of facilities do you have to accommodate a pet while you are gone.
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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.
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Your answer
Have you ever given up a pet, and if so, what was the reason(s).
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Your answer
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.
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Your answer
Does anyone in your family have known allergies to animals?
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Yes (please explain in additional comments)
No
How would you describe your household?
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Quiet
Lively
Active
Average
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.
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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.
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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.
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Yes, I have read & understand the disclosure.
Required
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