Hopeful Hearts Adoption Application

Your Full Name*

First NameLast Name

Partner's Full Name (if applicable)

First NameLast Name

Name of dog(s) you are interested in adopting*

Address*

Street Address

Street Address Line 2

CityProvince

Postal CodeCountry

Primary Phone Number*

Area CodePhone Number

Secondary Phone Number

Area CodePhone Number

E-mail*

How did you hear about Hopeful Hearts?*

Why do you want to adopt a rescued dog?*

Your Family

How many adults are in the home?*

Do you have any children?*

YesNo

If yes, what are their ages?

If you have children, have they been taught how to behave around dogs?

YesNo

Is everyone in your home agreeable to adopting a dog?*

YesNo

Does anyone in your home have allergies to animals?*

YesNo

Your Home

Type of home*

Do you have a yard?*

YesNo

If yes, is it fenced?

YesNo

Is there someone home during the day?*

YesNo

If not, how many hours per day will the dog be home alone?*

Where will the dog stay when he/she is home alone?*

Where will the dog NOT be allowed in your home?*

What is the activity level of your home?*

Calm & QuietActive & BusyHectic & LoudOther

Your Pets

Do you have any pets at this time?*

YesNo

If yes, please list incuding type, age, sex:

Are your animals spayed or neutered? If not, what is the reason?

Have you personally owned any pets in the past that you no longer have?*

YesNo

If yes, what happened to them? (be specific)

Have you ever surrendered a pet to an SPCA, humane society, or pound?*

YesNo

If yes, why?

How much daily exercise will you give your dog, and what kind?*

What type of behaviour/activity would you not allow, or would you give a dog up for?*

Are you willing to enter your new dog into obedience/training if need be?*

Are you willing to crate the dog if needed or crate train if not already?*

Please tell us when the most convenient time would be for a home visit*

Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Additional comments:

I have read the above stated application carefully and certify that the information I have given is accurate and true. I understand that any misrepresentation of the above information will lead to a rejection of this application.

I acknowledge that Hopeful Hearts cannot guarantee any behaviour. I will not hold Hopeful Hearts responsible for any damage to my house, yard, or personal possessions, nor seek any compensation for damages or other liabilities incurred.

I agree to be personally responsible for the humane housing and care of the animal(s) I adopt, and to be vigilant about safety for the dog. I will provide him/her with adequate food, water, shelter, training, affection and medical care. I acknowledge that Hopeful Hearts does not allow dogs to be kept outside and understand that my dog is to be kept inside with the rest of the family, as part of the family, and outside for activity, bathroom and fun only.

I agree that, if for some reason I am unable to keep my dog, the dog is to be returned to Hopeful Hearts Rescue. I agree not to sell, euthanize or give away a dog that I have adopted.

I authorize Hopeful Hearts to conduct an on-site inspection of the premises where the animal will live.

Date*

MonthDayYear

Hopeful Hearts Adoption Application

Veterinarian reference