Heartbeat4paws Pre-Adoption Application Form

Heartbeat4Paws, Inc.

ADOPTION APPLICATION FORM

Before meeting one of our adoptables, please complete this application.

* You must be 21 years or older to adopt.

* All animals in your home must be spayed or neutered and up to date on vaccinations/preventatives.

* It is strictly prohibited to house any animal adopted from HB4P outside.

Please take your time and answer the following questions carefully. Adopting an animal is a responsibility for everyone involved. It takes time and patience.

By adopting one of our rescued animals you will be giving this animal the chance to be a part of a loving family.

*Depending on the dog, we may only adopt within a 50-mile radius of Greenwood, Indiana

*I agree that all statements in this application are true and made based on personal knowledge and are made for purposes of my application to adopt one or more animals through “Heartbeat4Paws".

Name of Potential pet parent/Applicant *

First NameMiddle NameLast Name

Name of animal you wish to apply for/adopt*

Email Address*

Mobile phone number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Number of people involved in the care of animal*

Emergency contact other than someone in your home. Name and phone # *

Please provide your current (or previous) veterinarian's name and phone number: *

If you have any pets at the present time, please state species/breed/ages and if they are spayed/neutered *

If you have any pets at the present time, please state their behavior toward other animals *

Please provide the names, emails, and contact numbers for 2 personal references: *

Type of home?*

HomeCondoApartment

Do you have a fenced yard? (This may not be required for every dog) *No invisible/electric fences please*

YesNo

Type of and height of fence (chain-link/wood - 4ft; 6ft)*

I own my home and am permitted to bring an animal or animals into my dwelling*

YesNo

I rent my home and/or apartment and I am permitted to bring an animal or animals into my dwelling*

YesNo

Do you work from home? If not, how many hours each day will your new pet be home alone/crated?*

Do you have experience with animals of this type, please provide details*

Are there children in the home or that visit the home? (If yes, please list ages)*

Where will your pet/s stay when you are at home? *

Where will your pet/s stay at anytime you are not at home? *

Where will your pet/s sleep at night? *

How many hours per day would the pet be alone?*

Will you crate your pet?*

*Please type Applicant's Name in field* I understand that “Heartbeat4Paws” is very concerned about the security and safety of their rescue animal. I understand a“Heartbeat4Paws” representative may visit my home for a home inspection before my adoption application is approved. *

First and last name

*Email will be the primary method of communication from “Heartbeat4Paws”. If you do not check email regularly, please tell us how to best get in touch with you. *

Adopting Family...

I understand a “Heartbeat4Paws” representative will visit my home for a home inspection before any adoptions are approved.

I understand a “Heartbeat4Paws” representative may visit my home and/or contact me after adoption is finalized.

If applicable, adopter understands there is some risk to your own animals, especially if your animals are not kept separate. Adopter agrees Heartbeat4Paws is not responsible for any type of medical treatment/expenses.

I understand that Heartbeat4Paws can make no guarantee relating to the animals’ health, behavior or actions. I understand that I receive the adopted animal(s) at my own risk. I acknowledge that Heartbeat4Paws is not responsible for any property damage or personal injury suffered by me, members of my household, including my own animals, or any third parties, and I assume liability to provide adequate controls to prevent such damage or injury.

By clicking the submit button, I have read and understand the statements above. I certify that all the information contained in this application is true and correct.

Typed signature of potential pet parent and today's date*

Heartbeat4paws ~ Email: heartbeat4paws@gmail.com ~ (847)772-9472