ADOPTION APPLICATION

First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Work Phone
x

Cell Phone*

Which animal are you interested in? (Leave blank if you haven't decided yet or for a bonded pair, you only need to choose one)
Choose an animal: Abbi Addy (must be adopted with Diego) Arabella Arlo (must be adopted with Smudge) Ash Biggie Blanche Brently Bruce Buddy Buddy (must be adopted with Doddy) Captain James Hook CeeCee Chase Chester (must be adopted with Freddy) Chunk-a-Monk Coffee Cotton Cupid Daisy (must be adopted with Sunshine and Sunshine) Dallas Danny (must be adopted with Oliver and Oliver) Dash Diego (must be adopted with Addy) Doddy (must be adopted with Buddy) Domino Emma Felix Fiona Freddy (must be adopted with Chester) Ginger Ale Glinda Guy Haley Harlow Harper Holly Irving (must be adopted with Isabel and Isabel) Isabel (must be adopted with Irving and Irving) Jack (must be adopted with Manny and Manny) Jimmy Jingles Juan Carlos Kiki Larissa Laura Layla Lexi Lilo Lily (Lil LiL) Lourde Lulu Luna Luna (tabby) Lyusik Maggie (must be adopted with Sissy and Sissy) Malcolm Manny (must be adopted with Jack and Jack) Marius Maya Mickey Mikey Mikey Moo Miss Marilyn Miss Missy Missy Missy Mistletoe Mittens Monty Mr Smee (must be adopted with Peter Pan and Peter Pan) Mrs Peacock Oliver (must be adopted with Danny and Danny) Oreo Oreo (must be adopted with Jackie O and Jackie O) Oscar Oz Panda Penny Pete Peter Pan (must be adopted with Mr Smee and Mr Smee) Phil Pippin Pongo Pork Chop Precious (must be adopted with Shy) Raven Rooster Roxie Shy (must be adopted with Precious) Sissy (must be adopted with Maggie and Maggie) Sissy Smoosh Smudge (must be adopted with Arlo) Stringbean Sunny Sunshine (must be adopted with Daisy and Daisy) Sweetie Tandy (must be adopted with Tiki and Tiki) Taz Thunder Tiki (must be adopted with Tandy and Tandy) Titus Toby Toby Trevor Valentine Zach (must be adopted with Winnie) Zoey

What is your age range*
Choose one: Under 18 years old 18-24 years old 25-34 years old 35-44 years old 45-54 years old 55-64 years old 65-74 years old 75 years or older

Employer Name*

What is your occupation and your work schedule?*

In what type of home do you live?*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Other

How long have you lived at your current address?*
Choose one: < 1 year 1 - 3 years 3+ years

If fewer than 3 years, please list previous address*

Do you own or rent your home?*
Choose one: Rent Own

If you rent, have you received the approval of your landlord to have a pet?*

If you rent, please enter your landlord's name and phone number (Otherwise answer N/A):*

How many adults, including you, reside in your household? Please provide names, ages:*

How many children (under 18) live or stay in the home on a regular basis? Please provide age/gender of each child in the home*

Does anyone in your home have special needs?*

Does anyone smoke inside the house?*

Does anyone have allergies to animals?*

Do all household members agree to having a cat/dog in your home?*

Name of person financially responsible (if not applicant):

In the next year, do you have plans to:

Describe your home's activity level (check all that apply):

Have you applied with any other Rescue or Shelter?*

Do you currently have pets?

How many?

Please provide information on all your pet(s) - name, breed, sex, age, spayed/neutered (current and previous or deceased) pets in the last ten (10) years:

VETERINARY INFO: There are ongoing costs for the maintenance of your pet's optimum health. Are you able and agree to to incur these costs for the pet's lifetime that may include dental cleanings, periodic labwork, diagnostic tests, medications and/or surgery as recommended by your Vet?*

Do you give permission to H2H to verify with your veterinarian that pet vaccinations are current?*

Veterinarian's Name and Phone Number*

Please provide the name on your pet's Vet records (if different from applicant):

Have you ever given up a pet? If yes, please explain*

For cats only: Are you planning to declaw*
Choose one: Yes No N/A

Why are you interested in adopting a pet at this time?*

For whom are you adopting a pet?*

Who will be responsible for the care of the pet?*

What are the most important responsibilities in caring for a pet?*

Where do your current pets spend their time? (Check all that apply)*
Choose one: Indoors Only Outdoors Only In / Out Crated Basement Garage Porch Separate Room Other

Where will your new pet be kept? (Check all that apply)*
Choose one: Indoors Only Outdoors Only In / Out Crated Basement Garage Porch Separate Room Other

How much time will the animal spend alone during the day?*

Where will the animal be kept when you are not home?*

For dogs only: When the dog goes out, how do you supervise? (if this does not apply, answer N/A)*

For dogs only: Is your yard fenced? (if this does not apply, answer N/A)*
Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced N/A

What type of pet are you interested in adopting? (check all that apply)

Are you familiar with the techniques of introducing another animal into the household?*

In case of emergency or death, have you arranged for the care of your pet(s)?*

Please provide name, relationship and contact information of designated person to take care of your pet(s) in case of an emergency:*

List three references (Name, Relationship, Contact Number, Years known): *

How do you hear about Hart 2 Heart Animal Rescue?*

A virtual home visit is required as part of our application process. 

Hart 2 Heart requires you to present a government issued Photo ID upon adoption. We do not collect the information for any purposes other than to verify your identity. However, we understand if you're not comfortable sharing your driver's license number.

STATEMENT OF UNDERSTANDING All of the information provided in this application is true and correct. I understand that any knowingly false or incomplete answers may cause my application to be denied. If any of the information changes during the application process, I will advise you promptly. I give permission for Hart 2 Heart to conduct a background check, contact my landlord, veterinarian and personal references to verify supplied information. I understand that Hart 2 Heart is considered the guardian of the animal in question and has the right, in its sole discretion, not to approve this application. Completion of an application does not guarantee approval. There may be multiple applicants for an animal. Applications are processed in order of receipt. Approval is based on a background check and confidential guidelines in order to obtain accurate and truthful information. Do you accept this Statement of Understanding?*

Hart 2 Heart Animal Rescue provides equal opportunities to all applicants without regard to race, color, religion, sex, national origin, age, disability or genetics. H2H expressly prohibits any form of harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. H2H may use the information provided, including applicant's name, address and pets' information in order to evaluate your suitability to adopt an animal from H2H in accordance with our guidelines and policies, and this information may be shared with third parties. This information may also be used by H2H for promotional, public relations and fundraising purposes.

Thank you for your interest in our animals! We will be in touch with you as soon as possible.