GHR - Adoption Application

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Saturday, July 12th - Bark n' Purr Adoption Event

Saturday, July 19th - Pet Supplies Plus Adoption Event

Pre-Adoption Application

Today's date

Dog interested in*

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.

First name

Last name

Address

Phone (Day)

Phone (Evening)

Name of spouse/signficant other/roommate

Your occupation

Spouse occupation

If this relationship were to change, with whom would the dog remain

Do all adults in your household know you plan to adopt a dog*

Yes

Who will be primarily responsible for the dogs care

What are your reasons for adopting a dog

A companion for you

Your cat/dog

Spouse

Children

Gift? For who? Please explain below

Other

Please explain per above

Your type of dwelling*

House

Apartment

Condo

Mobile

Do you rent or own*

Rent

Own

If you rent, are dogs allowed*

Yes

N/A

Can you provide proof that your residency would allow a new dog

Yes

Does your residency have restrictions on breed, size or number of animals

Yes

In your selection of a dog what is your preference*

Age

Long hair

Short hair

Male

Female

Breed

Temperament

This dog will be*

Indoors only

Mostly indoors

Outside only

Mostly outside

Other (Please explain below)

Other explanation:

If you answered indoor only, please describe what outdoor access the pet will have (when will it go out, etc.)

If you have children that live or stay with you, please list their ages

Please list any other adult household members

Have your children ever been around dogs*

Yes

N/A

Do your current pets like dogs*

Yes

N/A

Have you ever bred a dog*

Yes

N/A

If yes, did you breed for*

Fun

Show

Profit

Accidentally happened

N/A

List pets you currently own*

Type & age*

Spayed/neutered*

Yes

N/A

Kept inside or outside*

Inside

Outside

N/A

When did you own this pet & what happened to it*

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

Please explain

Do you have a fenced yard*

Yes

N/A

Type of fencing*

Chain link

Block wall

Wood

Other (please explain below)

N/A

Please explain

Do you have gates?*

Yes

N/A

Do the gates have locks?*

Yes

N/A

Other provided living areas

Garage

Unfenced yeard

Kennel run

Other (Please explain below)

N/A

Please explain*

Do you have*

Balcony

Pool

Pet door

N/A

If you have a pool, is it secured or separately fenced*

Secured

Separately fenced

N/A

Have you tied your dog up*

Yes

N/A

Where will your dog sleep during the night*

In what areas of the house will the dog be allowed

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

If yes who

Please provide name, address and phone number

Who is your current or last veterinarian (name,address,phone)

Will your dog be allowed on the furniture*

Yes

N/A

If not, how will you train your dog not to jump on your furniture

Would you allow an inspection of your home/yard*

Yes

How do you plan on housebreaking your new dog? (Please understand that even dogs that are housebroken will go through an adjustment period)*

Are there any reasons that might preclude you from being able to properly care for your new pet

Yes

If yes, please list reasons

Under what conditions would you not keep your new dog*

Move to a place that didn't allow your dog

Move out of state

Too much hair

Dog grew too big

Chewing

Barking

Digging

Housebreaking problem

Kids ignored pet

New baby

Allergy

Pets didn't get along

Destructive behavior

Family changes/new relationships

Expensive vet bills

Other (please explain below)

N/A

Please explain

If your dog develops behavioral problems, what would you do*

If you have a family changes such as a new baby how would you integrate your new dog*

What would you do with your dog if you could not keep it for some reason*

Do you travel a great deal

Yes

Where will your pet stay when you are on vacation*

Have you ever trained a dog in obedience class*

Yes

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

How did you hear about this pet adoption

Internet

Friend

PETCO

Other (please explain below)

Please explain

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 $100.00/DOG*

Yes

Signature

Signature field is empty.

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.