Why are you interested in adopting at this time?*
Tell us about your ideal pet, and what traits you may be looking for in a companion animal (for example, I'm looking for a family dog, walking/jogging partner, a couch potato/snuggle buddy, a guard dog, a buddy for my other resident animal, a pet for my child, etc.)?
What steps have you taken to learn about dog ownership, training and breed health/traits that might be applicable to the dog you are interested in adopting?*
What is the name of the dog you are interested in adopting?*
Choose an animal:
Interested in more than one dog? Select his/her name below
Choose an animal:
Where will the dog live? *
Where will the dog be kept when you are not home?*
Where will the dog sleep?*
How much time will the dog spend alone during the day? If broken up by a lunch break, please specify. *
How will you exercise the dog?
Do you plan to take the dog to obedience classes? If no, please explain your past experience with dog training/socialization. *
Including yourself, how many adults reside in your household? List names, ages and relationships*
Are there any children living in the home or who visit frequently? If yes, list ages.*
Are all members of your household on board with adding a new pet to the family?*
Who in the household will care for the pet?*
Does anyone living in your home smoke cigarettes?*
Yes, both inside and outside the home
Yes, only outside the home
In what type of home do you live?*
Do you own or rent your home?*
If you rent, have you received the approval of your landlord to have a dog?
If you rent, have you confirmed that the dog(s) you are interested in does not fall into any breed/weight restrictions that your landlord may have?
If you rent, please enter your landlord's name and phone number
Are you familiar with your city ordinances pertaining to pet ownership and licensing? *
Is your yard fenced?*
If yes, please describe what type of fence you have (privacy, chain link, invisible, etc.), it’s height and condition. Is it secure?
What Veterinarian (clinic name and phone number) do you use for your current pet(s)? If you do not have any current pets, please list the vet you plan to use or if unsure, just write "unsure".*
Do you currently have pets?*
If yes, please list your current pet’s breed, age and gender
Are all dogs and cats in your home currently spayed or neutered? *
If one or more of your pets are not fixed, please describe why.
Please list your current pet’s diet and/or planned diet for your new pet including brand of food and type (kibble, canned, freeze-dried, home-made, raw, etc)*
Is your current pet(s) at a healthy weight?
If no or unsure, please explain.
Please describe your current pet(s) health and activity level
Please tell us about your past pets and/or experience with companion animals (For example, what type of pet? How was your pet obtained? How long did you have it? etc.).
How did you hear about Healing Hearts Rescue?
Pet adoption website (Petfinder, Adopt-a-pet, etc.)
Referral from a person
I want to stay connected so I can help save more lives through rescue. Please sign me up for Healing Hearts Rescue emails
Do you have any travel plans scheduled in the next 30 days? If yes, please describe.*
If for any reason you cannot keep your adopted pet, do you agree to return him/her to Healing Hearts Rescue?*
What are the reasons you might consider returning your adopted pet back to our rescue?*
Is there any other information you would like to provide us with?
Personal Reference 1:
Please list the name, phone number, email and relationship to you*
Personal Reference 2: Please list the name, phone number, email and relationship to you*
Personal Reference 3: Please list the name, phone number, email and relationship to you*
I certify that the information entered on this applicant is true. Enter your NAME and DATE.*
IMPORTANT - if you do not see a pop up box after you hit "submit" saying "Your form has been submitted! Be sure to scroll to the top of this webpage for more information!", your form was not submitted. If you are having issues, take a screen shot of your answered questions and email us at firstname.lastname@example.org.