Adoption Application
Thank you for considering adopting a rescued animal from Healing Hearts! 
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Email *
Which of our rescue pets interest you? (We make careful decisions matching pets to adopters based on the needs of both. We cannot guarantee that you will get the pet you apply for, but we will keep your application on file.) *
PERSONAL INFORMATION
Last name, First name *
Street Address *
City *
State *
Zip Code *
Email address *
Home phone
Cell phone
Employer *
Type of work *
RESIDENCE
Check residence type *
Required
How long at this residence? *
Rent or own? *
Required
If you rent, fill in your landlord's contact information: Name/Phone/Email (We may contact the landlord regarding pet policies.) *
Type of fence (check all that apply) *
Required
Fence construction (check all that apply)
If no fence, how will you exercise your pet (if applicable)?
Do you have a doggy door? *
If you are adopting a dog, how will you supervise it outdoors?
HOME LIFE
List all people living in the home, including yourself: name/age/relationship *
Does anyone in your family have pet allergies? If yes, who?
How would you describe your household? (check all that apply) *
Required
If adopting a dog, how long would it be left alone in the home daily, on average?
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If adopting a dog, what are your plans for when you are out of the house? Where will your dog stay? Please be specific, i.e., run of the house, a particular room, in a crate?*
Where would an adopted dog sleep at night?
If you travel, who will take care of your pet/s when you're away? *
Who will be primarily responsible for the adopted pet's daily care? *
Who will be financially responsible for the adopted pet? *
Do you agree to keep the adopted pet as an indoor pet except for exercise and toileting? *
OTHER PETS
List each pet currently in the home:  Name, Age, Breed, Gender, Weight AND their personality traits (ie docile, lovable, jealous) *
List names and breeds of all pets you've owned in the past (excluding present pets) and where they are now/reason for passing. *
PET WELLNESS
Have you ever surrendered a pet? *
If yes, explain when and under what  circumstances.
For what reason(s) would you ever return or surrender a pet in the future? *
Do you agree to contact Healing Hearts Canine Rescue if you can no longer care for the adopted pet? (This is a requirement in our adoption contract.) *
Please describe any health issues (injuries, surgeries, diagnosis) your current or previous pets may have had and how each was treated?*
Are all the animals in your home spayed or neutered? *
If your animals are NOT spayed or neutered, explain why not.
Are all the animals in your home up to date on vaccinations? *
Do you currently use heart worm preventative?  *
Are you willing to take your adopted pet to a licensed veterinarian at least once per year for a check up and vaccinations?. *
FOLLOW UP
Are you willing to have a virtual or in person home visit if Healing Hearts Canine Rescue requested one? *
If no, why not?
Current Vet: Name/Address/Phone number (Please tell your vet we may be contacting them for a reference check and give them permission to release information to us.) *
REFERENCES

Please list three people who are familiar with both you and your pets. List at least one NON-FAMILY reference.

Reference 1 Non-family Name/Relationship/Address/Phone *
Reference 2  Name/Relationship/Address/Phone *
Reference 3  Name/Relationship/Address/Phone *
CONTRACT ACKNOWLEDGEMENT
I acknowledge this application becomes part of my contract should I adopt from Healing Hearts Canine Rescue. *
A copy of your responses will be emailed to the address you provided.
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