HART Dog Adoption Application

Your Full Name *
Please type the name of the dog you wish to adopt *
In case the first dog of your choice becomes unavailable, please list the name(s) of other adoptable dog(s) you wish to adopt. *
It is our policy to make certain that each person who adopts a dog is aware of the responsibilities of pet guardianship, and is capable of and willing to accept those responsibilities morally, physically and financially. Not every person who desires to adopt a dog should do so. Before you complete this application, please note the following: If you are a first time pet owner, please expect extended processing time. Please make sure you provide all documents that you think will aid in your application process. Documents include, but are not limited to, other family members vet records, proof of pet-sitting or pet experience, etc.
	I am not a first time pet owner.
	I am a first time pet owner and I understand the statement above.
	I do not have any vet history or vet information to provide.
	I understand the statement above and I will provide my vet information.
PERSONAL INFORMATION
Date *
If the dog of interest is a bully breed are you aware of your insurance policy coverage for owning certain breed types?	NoYes
First Name *
Last Name *
Age *
Name of
	Spouse
	Partner
Street Address *
City, State, Zip *
If less than two years at address please provide previous address
Drivers License Number *
*	Check this box after you email a picture of your Driver's License to hartshelterteam@gmail.com
Please make sure the name on the License matches the name on this application
Does your driver’s license reflect your current address? *	NoYes
If not explain why
Home Phone
Work Phone
Cell Phone
Email Address *
Facebook Name, if applicable
Name of Business, Occupation Title, Address & Phone
How long have you been on this job?
Partner's Name of Business, Occupation, Title, Address & Phone
How long has your partner been at this job?
What is your work schedule?
What is your partner's work schedule?
List the names of all persons living in your household, their relationship to you and ages:
Please list two personal references: (Other than Family Members)
First Reference
Name *
Phone Number *
Relationship to you *
Second Reference
Name *
Phone Number *
Relationship to you *
YOUR HOME
Type of dwelling? You will be asked later to share photos of your home and yard	House Apt Condo Other
Do you...	Own Rent
Is your home on a busy street? *	NoYes
If you have a yard, is it...	Fenced Unfenced I don't have a yard
If you have a fenced yard, what is the height of the fence in inches? You will be asked to provide photos of your fence.
If you have a pool, is it fenced, if not how would you introduce a dog to your pool?	NoYes
Would you allow an inspection of your home by a rescue volunteer? *	NoYes
If you do not own your home, do you have the landlord’s permission to have a dog?	NoYes
If Applicable, Landlord’s Name
If Applicable, Landlord's Number
YOUR COMPANION ANIMALS
Do you presently have a dog? *	NoYes
Have you previously had a dog? *	NoYes
CURRENT PETS
Do you give your dog(s) (past or previous) Heart Worm Preventative? *	NoYes
If yes what kind of prevention does your dog receive?
Does your dog (current or past) receive routine annual heartworm testing? *	NoYes
If your dog is NOT on heartworm prevention please explain why
More on your current pets In the following section, we would like to know more about your current pets. This includes: Names of your current pets, species (cat/dog etc), breed, age, gender, neutered/spayed, if declawed and if they are kept indoors or outdoors,etc.
Please tell us how many dogs, cats, other you currently have (Include each pet's name) *
Please tell us each of your current pet's age, breed, sex and whether they are spayed/neutered. *
Please tell us whether you keep your current pets indoors and/or outdoors. *
Please tell us how long you have had each of your current pets. *
PREVIOUS PETS In the following section, we would like to know about your previous pets. This includes: Names of your past pets, species (cat/dog etc), breed, age, gender, neutered, if declawed and if they were kept indoors or outdoors,etc.
Please tell us how many dogs, cats, other you previously had and no longer have (Include their names): *
Please tell us each of previous pet's age, sex and whether they were spayed/neutered. *
Please tell us whether your previous pets were kept indoors and/or outdoors. *
Please tell us what happened to each of your previous pets (e.g. Gave away, sold him/her, took to the pound, abandoned, died, ect.). If your previous pets have died, please state the cause of death and the age of death. *
Have any of your dogs ever had puppies *	NoYes
If yes, do you breed for:	Fun Profit Show Accident Not Applicable
Has any member of your family ever experienced animal-related allergies?	NoYes
If yes, please explain
Have you ever trained a dog in obedience classes? *	NoYes
Have you ever trained a dog (Select all that apply)	Basic Commands Herd Hunt Guard Attach Other
If other, please explain
Have you ever surrendered a pet to a facility or shelter? *	NoYes
If yes, please indicate (1) for what reasons, (2) where and (3) when
YOUR FAMILY VETERINARIAN(S)
Vet Name (Under what Name Used, and what pet(s) name used) *
Veterinarian Phone Number *
YOUR NEW DOG
Who would be responsible for the care of the dog? *
What is your primary reason for adopting a dog? Select all that apply.	Companion Guard dog Hunting Attack dog Working (herding) Other
If companion, whose?
If Other, please explain
Where will the dog sleep?	Inside Outside Both
If the dog will sleep inside, where inside?
If the dog will sleep outside, where outside?
How many hours per day will the dog be left alone? *
How many minutes & or hours will the dog be left unattended inside *
Where will the dog be left when he/she is alone?	Indoors Outdoors Both
If outdoors, where?	Yard Patio Kennel Garage Other
If yard: Do you have a doggie door?	NoYes
If other, please specify
Do you intend on crating your new dog, if so how long of a time *
If your home does not have a fence how do you plan on taking your dog out for bathroom breaks, On leash, off leash, teaching boundaries? Please explain. *
Do you intend to hire a dog-sitter or take the dog to a daycare center? *	NoYes
When you are at home, the dog would be:	Indoors Outdoors Other
If other, please specify
Which rooms or areas of the home/yard will be off-limits to the dog? And Why? *
How will you socialize your new dog *
Do you allow dogs on furniture?	Yes No Some
If some, which?
If the dog will be outside at all, what outside space is available for the dog (Select all that apply)	Fenced Yard Patio Dog Run Balcony Unfenced Yard Other
If other, please specify
Are the gates....	Latched Padlocked Other
If other, please specify
How do you plan to handle the dog’s exercise needs? *
If necessary, would you be willing to attend obedience classes at your own expense? *	NoYes
Do you travel a great deal? *	NoYes
How often? *
How long at a time? *
When you travel, how do you intend to provide for the dog while you are gone? *
What are your beliefs on spaying and neutering? *
What provisions would be made for the dog if you had to move locally? *
What provisions would be made for the dog if you had to move out of state? *
What provisions would be made for the dog if you had to move to a place where no pets are allowed? *
Under what circumstances would you give up/give away the dog? (Choose all that apply)	Divorce Illness in family Moving New baby New Job Housetraining problems Chewing Barking Digging Allergy Shedding to much Dog grew too big Dog becoming ill Kids ignore the cat Pets did not get along Not obedient enough Other Would not give up for any of above reasons
If other, please specify
What would you do if the dog grows to be bigger than you expected? Select all that apply.	Return dog to rescue Take dog to shelter Keep but keep outside Other
If other, please specify
If the dog becomes destructive at your home, what would you do? *
If the dog has “accidents” at your home, what would you do? *
If the dog shows Separation Anxiety, what would you do? *
If the dog becomes aggressive to people and/or other dogs, what would you do? *
If yes, is there a maximum amount you would spend for your dog's medical needs? How much is it? And what is/are the reason(s)?
If the dog becomes ill or injured, are you financially prepared to provide the medical care? *
The dog may live 15+ years. What would you do with your dog if you could no longer care for them? *
Is there anything else you would like to tell us about yourself?
Questionnaire Information All the information I have provided in this Questionnaire is true and accurate to the best of my knowledge. If any of the information changes, I will advise you promptly.
Date *
Full Name *
PLEASE ALLOW SEVERAL DAYS FOR THOROUGH PROCESSING OF APPLICATIONS. APPLICATIONS ARE APPROVED BASED ON BEST MATCH, NOT FIRST COME-FIRST SERVE. THANK YOU FOR YOUR PATIENCE AND UNDERSTANDING. Please review your application to ensure that it is filled out accurately and honestly. An incomplete application will NOT be reviewed. Dis-honesty will automatically null and void any adoption of an animal. No person will be allowed to adopt any animal that has a criminal background, charges or convictions.