heavenlyheartsrescue.org - Adoption Application

Thank you for your interest in adopting from Heavenly Hearts! Our adoption application is a convenient online document that you can fill out and submit from our Website.

Keep in mind that application approval is possible only if:

1. You are at least 21 years old.
2. Your current pets are spayed/neutered, up to date on vaccinations, heartworm tests and heartworm preventive. (We check vet references.)
3. You are willing to have a home visit prior to adoption, and follow-up visits as needed.
4. You own your home. We may make a rare exception for renters if you can meet the following requirements: (1) show a positive and stable rental history, (2) provide written landlord approval, and (3) have an outstanding veterinary reference for current and/or past pets.

Adoption Application
Note: This application has no "save for later" feature! Please have all information ready before you begin. If you click "submit" before you are done answering all of the questions, you will have to re-enter all information again from the beginning. We do not review or consider incomplete applications!

If a question does not pertain to you, please do not leave it blank. Rather, put N/A in the answer field. Thank you.

Name: (First, Middle Initial, Last)
Email Address:
Name of animal you are interested in?
How did you hear about Heavenly Hearts Rescue? (Check all that apply.)	Petfinder.com Internet search Word of mouth Community event Morning Blend TV show Adopted from HHR before Other
Full address, including city, state and zip code:
Daytime phone number, with area code:
Evening phone number, with area code:
What is your date of birth? (mm/dd/year)
What is your occupation?
Marital status?
If married, what is your spouse's name? (First, Middle Initial, Last)
If married, what is your spouse's date of birth? (mm/dd/year)
If married, what is your spouse's occupation?
What type of residence do you have?
Do you rent or own your residence?
If you rent, can you demonstrate a positive and stable rental history?
If you rent, are you able to obtain your landlord's written permission to have a dog?	Yes No Request Pending
If you rent, what is your landlord's name and phone number?
Do you plan on moving in the next year?	Yes No Not sure
Please provide two personal references, at least one of which is not a family member. Include each person's name and a current phone number.
How do you know each person you listed as a reference, and how long have you known him or her?
Would this be your first dog?	Yes No
What has been your experience with dogs?
What training/educational experience have you had with dogs? Please be specific (e.g. training classes, books, formal education, volunteering, etc.).
Do you have children under the age of 18 living in your household?	Yes No
If yes, please list their ages.
If you have children, have they had exposure to or experience with dogs? Please describe.
Excluding yourself, spouse and children, list anyone else living with you. Please provide a name and relationship to you for each person.
Is everyone in the household aware of the decision to adopt a dog?	Yes No
Who will be the person responsible for the daily care of the dog (e.g. feeding and exercise)?
What is the activity level of your household?
What activity level are you looking for in a dog?
Are you aware of your local animal ordinances (number of dogs allowed per household)?	Yes No
Where will your dog be kept during the day?
Where will your dog be kept at night?
If planning to crate, how many hours will dog be left without a break?
Do you have a fenced yard?	Yes, fully fenced Yes, Invisible Fence Partially fenced No fence
If you have a fence (other than Invisible Fence), what type is it and how high is it?
If you do not have a fence, do you plan to fence your yard? If so, when?
If you do not have a fence and do not plan to get one, how will you confine your dog to your property?
List all forms of exercise your dog will receive.
Will your dog be primarily an indoor dog or an outdoor dog?
On average, how many hours will your dog be left alone each day?
On average, how many evenings per week do you spend at home?
Are you and/or your family frequent travelers? If so, please explain how you will accommodate your dog while you travel.
Please provide an example of how your would correct your new puppy/dog if it showed destructive or inappropriate behavior (e.g. digging, chewing, or jumping).
Do you plan to take your new dog to basic obedience classes?	Yes No Not sure
Are you willing to pay for and attend obedience classes if necessary to address behavior issues that may arise?	Yes No
If you currently own a pet, please tell us the breed and age of each.
If you have current pets, have they been introduced to other animals? How did they react?
If you have current pets, do you understand the steps to successfully introduce your new dog to them?
In addition to those listed above, please list all of the pets you have owned in the past seven (7) years. If you no longer have them, please tell us what happened to them.
Have you ever had to surrender a pet to a shelter or rescue? If yes, please tell us the circumstances.
Did your pets, current or past, receive annual veterinary care?	Yes No
If no, please explain.
If you have current pets, are they up to date on vaccinations?	Yes No
If you have current pets, are they on heartworm preventative and tested yearly for heartworms?	Yes No
Please list the name and phone number of your veterinarian (if you have one).
Whose name is on the account?
If you do not have a current veterinarian, list a vet you have used in the past or plan on using in the future.
Are you aware of the annual routine vaccinations recommended for the health and protection of your dog?	Yes No
How much do you think it will cost to take of your dog each year? Include food, supplies, vet care, and the possibility of major medical expenses in your estimate.
Are you financially prepared to care for this dog, including emergency medical needs? Please be aware that emergency or major medical care can be expensive.	Yes No
Is anyone in your household allergic to dogs?	Yes No Not sure
If yes, is that person currently on allergy medication?	Yes No Not applicable
What are your reasons for adopting a dog? Check all that apply.	Companion for me Companion for my pet Companion for my children Gift Hunting Watchdog Personal Protection Want to do a good thing by adopting a homeless dog Other
While every attempt is made to assure the health of our dogs, we cannot guarantee the health of every animal, nor can we be held responsible for its behavior after adoption.
If for any reason you are unable to keep this dog, health reasons or otherwise, you are required to contact Heavenly Hearts Rescue for the return of the animal without making any charges of any kind. If you need to return the dog for health reasons, you may do so within ten (10) days from adoption, if a wellness exam is done by your veterinarian within seven (7) days of adoption.
If there is a valid health reason that was unknown to adopter at the time of adoption, a refund may be issued with the return of the animal. This is at the discretion of Heavenly Hearts Rescue to determine whether a refund will be given.
If you are not prepared to handle behavior issues that arise, or financial responsibilities associated with owning a dog, it is in your best interest (and the dog's) to postpone adoption at this time. Should you decide to postpone or take time to reconsider, we understand and appreciate your honesty.
I have read the application carefully and certify that the information I have given is true and complete. I understand that omission of information, failure to respond, inaccurate information, or failure to agree to policies contained in this application may result in this application being declined.
If an omission or untruth in this application is discovered after the adoption is complete, I understand that Heavenly Hearts Rescue has the right to annul the adoption and reclaim the dog. I further understand that I must cooperate by returning the dog and that this will not result in a refund of the adoption fee.
The applicant understands that adoption of a companion animal carries with it a responsibility to ensure the well being of the animal for the duration of its life. This includes providing adequate food, water, shelter, and veterinary care along with appropriate training and affection.
Thank you for taking the time to fill out this application. By submitting this form you agree to all policies stated within. At the time of adoption, you will be asked to sign an adoption contract and any other forms necessary to complete the process. We will contact you soon to discuss your application.

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