Adoption Application

Name of Animal you are interested in: *
Applicant’s Name: *
Age of Applicant: *
Number of Adults: *

Children in the household? *
YesNo

Name(s) or whom you live with: *
Age(s): *
How often? *
Age(s): *

Email address *

Phone(cell) *


Address:

Street Address *

City *
State / Province / Region *
Country *

Do you live in a: *
HouseTownhouseCondoApto
Do you: *
OwnRent
Do you have an enclosed yard? *
YesNo
How tall is the fence?

Do you have a pet size, weight, number of pets allowed limit where you live? *
YesNo

If yes, please describe:


Landlord Name & Phone Number:

May we contact your landlord to confirm pets/sizes are permitted? *
YesNo
Would you agree to a home visit to ensure the safety & security of the pet? *
YesNo

Where would the dog stay during the day? *
IndoorOutdoorBoth
Do you crate your pets? *
YesNo
If so, how many hours at a time? *

Where will your dog sleep? *

How many hours will the dog typically be left home alone? *

Do you know that dogs require yearly vaccinations? *
YesNo

Do you currently have a vet? (vet info to be listed in reference section) *
YesNo

Have you ever surrendered to a shelter or rescue or given away your pet? *
YesNo

If yes, please describe:

Please list current pets: Type of Pet, Age, Sex, Spayed/Neutered, Indoor/Outdoor.

Are your current pet(s) on monthly heartworm and flea/tick preventative? *
YesNo

REFERENCES:


Current or previous vet to contact for vet reference:
Full Name *

Phone *


1st PERSONAL REFERENCE:

Full Name *

Phone Home *
Phone Cell *

I certify that all information in this application is true, and I understand that false information may void this application. I agree that upon adopting a pet from iHeart Animal Rescue, I will agree and abide by their Adoption Agreement.