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Pre-Adoption Application

Pet ownership is a serious responsibility. The policy of this adoption group is to assure that each person who adopts a pet is aware of the responsibility, and that each is capable and willing and ready to accept that responsibility morally, physically, emotionally and financially. It is quite

true that not everyone who desires to own a pet should have a pet.


The following questionnaire has been designed to aid both you and the adoption group in deciding if you and/or your family is indeed at this moment adequately prepared to assume the type of responsible ownership which we are endeavoring to assure for our adoption animals.


Please be sure to answer all questions and feel free to add your own comments. If a question

does not apply write N/A.

Do all adults in your household know you plan to adopt a dog
Yes
No
What are your reasons for adopting a dog
Your type of dwelling
Do you rent or own
Rent
Own
If you rent, are dogs allowed
Yes
No
N/A
Can you provide proof that your residency would allow a new dog
Yes
No
Does your residency have restrictions on breed, size or number of animals
Yes
No
In your selection of a dog what is your preference
This dog will be
Indoors only
Mostly indoors
Outside only
Mostly outside
Other (Please explain below)

Other explanation:

Have your children ever been around dogs
Yes
No
N/A
Do your current pets like dogs
Yes
No
N/A
Have you ever bred a dog
Yes
No
N/A
If yes, did you breed for
Fun
Show
Profit
Accidentally happened
N/A
Spayed/neutered
Yes
No
N/A
Kept inside or outside
Inside
Outside
N/A
In regards to the above questions, what happened to your pet(s)
Hit by car
Old age
Died of disease
Gave away
Gave to shelter
Other
Do you have a fenced yard
Yes
No
N/A
Type of fencing
Do you have gates?
Yes
No
N/A
Do the gates have locks?
Yes
No
N/A
Other provided living areas
Do you have
If you have a pool, is it secured or separately fenced
Secured
Separately fenced
N/A
Have you tied your dog up
Yes
No
N/A
How many hours per day on average will the dog be left alone
0-4
4-6
6-8
8-10
10-12
Over 12
N/A
Do you have a relative who would adopt the pet if you, for any reason, become incapable of caring for him or her? (Note: Green Heart Rescue, Inc reserves the right to approve this individual)
Yes
No
Will your dog be allowed on the furniture
Yes
No
N/A
Would you allow an inspection of your home/yard
Yes
No
Are there any reasons that might preclude you from being able to properly care for your new pet
Yes
No
Under what conditions would you not keep your new dog
Do you travel a great deal
Yes
No
Have you ever trained a dog in obedience class
Yes
No
N/A
Will you be able to live with fur on your furniture, stains on your rugs, a warm body on your bed, and an animal who may be destructive at times
Yes
No
How did you hear about this pet adoption

ADOPTIONS WILL REQUIRE A HOME CHECK FOR THE SAFETY OF THE PET. IN THE EVENT THAT MY APPLICATION IS ACCEPTED, I AGREE AND CONSENT TO HAVE A VOLUNTEER VISIT MY HOME AT A MUTUALLY AGREED UPON TIME. I ALSO GIVE CONSENT TO GREEN HEART RESCUE TO CONTACT MY CURRENT OR PAST VETERINARIAN.

I UNDERSTAND THAT SHOULD I BE ACCEPTED TO ADOPT THIS PET THAT THIS APPLICATION BECOMES PART OF THE ADOPTION CONTRACT AND THAT THE ADOPTION FEE IS $75.00/DOG
Yes
No

THANK YOU FOR TAKING THE TIME TO COMPLETE THIS APPLICATION.

PLEASE NOTE: Filling out this application DOES NOT guarantee an adoption. We have thoroughly evaluated all of the animals in our care, and try very hard to match the right dog to the right person and situation. Adoptions are not on a first come first serve basis. We reserve the right not to adopt.

If we do not call or email you within 3-4 days of receiving your application, it means that either:

1. The dog was adopted by another applicant, or

2. We felt that the situation presented on the application was not the right situation for that particular dog.

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