Adoption Application | Hearts & Paws Rescue

Name of Animal Interested in Adopting:

Description of animal or distinguishing marks:

First name

Last name

Phone

Email

Address

City, State and Zip

Driver's License Number

DL State and Expiration Date

Date of Birth

How many people are living in your home (including you)? Please indicate ages of all children.

Does any member in your household have allergies?

Do you have a fenced in yard? If yes, what type of fence and how tall is the fence?

If you rent, please provide your landlord's name and phone number:

How long have you lived at your current address?

Are you in agreement with a home visit by a representative from Hearts & Paws Rescue before adotpion is approved? If no, please explain:

Part of our adoption process is to make a home visit after the adoption is complete. Do you agree with this visit? If no, please explain:

Have you ever been arrested? If yes, please explain:

Have you ever been convicted of a felony? If yes, please explain:

Who are you interested in adopting a pet for? If yourself or your family, please indicate.

Why do you wish to adopt?

Who will be responsible for the care and cost of the pet?

Will the pet reside at your address?

Where will the pet be left during the day?

Where will the pet sleep?

Who will care for the pet when you are on vacation?

Are you willing to spay/neuter the pet and pay additional refundable deposit after the pet is spayed/neutered? Note: Proof of spay/neuter must be provided to the rescue no later than the animal turning 7 months old or the animal will be reclaimed by the rescue and all deposits and fees will be forfeited. Note: a legally binding spay/neuter agreement must be signed.

Have you ever adopted before? If so, from where? Please indicate if you have ever surrendered an animal to a shelter.

Have you had an animal die in your home in the last 3 months? If yes, please explain.

List all animals currently in the household. Please include type, age , gender, and if they are spayed/neutered and vaccinated (indicate for each animal):

Please list any animals you have had in the last 5 years that are not listed above.

Veterinarian's Name, Address, Phone Number. Please make sure to call your vet's office and give them authorization to speak to Hearts & Paws Rescue.

Type Full Name - by entering your name you are electronically signing this application/agreement.

Adoption Application & Agreement