TLC Rescue: Dog Adoption Application

Big Heart Animal Rescue Adoption Application
Submitting this application does not mean you are commiting to an animal, nor does it guarantee you will get that animal. It is simply a tool we use to help both you and us identify a good potential match for your family and lifestyle. A successful adoption depends on selecting the right pet for your household and a good understanding of the animal's needs and care requirements. Please help us with this process by answering all questions honestly and completely.

Big Heart Animal Rescue reserves the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoptions.
Name and type of animal you want to adopt*
Adopter's Name*
First & Last Name
Co-Adopter's Name
First & Last Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Adopter's E-mail*
Co-Adopter's E-mail*
Phone Number*

Area CodePhone Number
Phone Type*

CellHomeWork
Names and ages of all permanent residents of your home (adults/children)*
Do you currently have any pets?*

YesNo
If you currently have pets, please list them below.
Are your current pets altered?

YesNoWill be within the next 30 days, appointment has been scheduled. (We will call your vet to verify this.)
If your current pets are not altered, please explain why below.
Vet reference (please call your vet and give permission to release information to us)*
Vet name, address & phone number
Two Personal References*
Are you planning to move in the near future?*

YesNo
If moving soon, to what city/state?
When will you be ready to adopt this animal?*

TodayThis weekendWithin a weekWithin a monthNot ready yet, just researching
Are you in contact with any other rescues or shelters about a specific animal?*

Yes, application is pendingYes, just an email inquiry, no app yetNo, but I am looking at several animals onlineNo, I am only interested in this particular animal
Are you going to meet another animal?*

YesNo
If so, when?
Is anyone in your home allergic to animals?*

YesNo
Does anyone in your home fear animals?*

YesNo
Does anyone in your home smoke?*

YesNo
Are you familiar with pet regulations in your area?*

YesNo
If you answered no to the question above, please contact your town/county/condo assoc and ask them what the regulations are.
If yes, please describe local pet regulations and restrictions:
I/We live in a*

Single Family HomeDuplex/TwinCondo/TownhomeTrailerApartment
Do you rent or own this property?*

RentOwn
Renters, have you contacted your landlord to find out if there's any restrictions on the kind or size of pet you can have?

YesNoNot yet, but I willIt's written in our lease
If you rent, you must show us a written letter from your landlord or a copy of the section of your lease stating that you are allowed to have pets and showing any limitations. If you live in a condo or townhome, you must show us written proof that you are allowed to have a pet there and show any restrictions.
Approximate square footage of your home*

Less than 800 square feet800-1,000 square feet1,000-1,500 square feet1,500-2,000 square feetOver 2,000 square feet
Do you have a yard?*

Yard, fenced with a vertical fenceYard, fenced with invisible fencingYard, no fenceNo yard (apartment/condo/townhome)
If vertical fence, what is your fence height?

2' high3' high4' high5' high6' high
Approximate dimensions of your lot:*
Do you work outside the home?*

YesNoOne applicant is home/works from homeWe work different shifts
If you work outside the home, how many hours per day are you away?
How many hours per day will this animal be alone? Please explain.*
Have you discussed this adoption with all members of your household?*

YesNoYes, adults have discussed. Kids don't know yet.
We will be speaking to all adult residents to confirm everyone is aware of this application process and wants to have a pet added to the family. Please do not submit this application if you are "trying to talk someone into" adopting this animal or think "once they meet the animal, they will want one" or "I'm getting this animal as a surprise birthday present for them." In those scenarios, you are welcome to email us to discuss the animal, but we would like all adults in the home to be involved in that email discussion.
Upon meeting the animal, what would give you cause to not want to adopt it? Please explain.*
Fantasy question: What would your dream pet be like? (If this animal is not a fit, we may be able to recommend another based on what you say here.)*
How much do you feel you can reasonably afford and would be willing to spend on your pet per year (for things like veterinary care, licensing, ID tag, food, toys, crate, other supplies, training, pet sitting, etc)? *
What activity/energy level do you prefer?*

Wild and crazy is coolLeash trained daily jogging partner would be excellentMedium energy, plays a bit then hangs out with youLow energy, walks slowly on leash, a total couch potatoOther
Please check all that apply. I want to adopt this animal...*

As a family petTo breed with my petTo train/use for huntingTo train/use for agilityTo train/use as a therapy animalTo train/use as an assistance animal for the disabledTo use as a guard dogFor a jogging/hiking partnerTo interact with lots of friends/familyAs a gift for a friend, partner, or family memberAs a companion for my dog(s)As a companion for my cat(s)As a companion for my child/children
Please check all that apply. My adopted pet will...

Be kept outside most of the timeBe kept indoors most of the timeBe left outside during the work day while we are awayBe kept inside while we are awayBe crated when we are not homeHave free reign of the house when we are not homeBe taken to formal obedience classesBe trained by me/usTake frequent car rides with usBe kept on a lead line/cable in the yardBe mostly interacting with adultsBe interacting frequently with children under 8Be interacting frequently with older childrenMust be housebroken prior to adoptionWill be housetrained by usWill be walked more than one mile per day every dayWill be walked occasionallyBe attending formal group obedience classes with usBe trained by us without the advice of a trainerHave private sessions with a trainer as neededBe attending agility classesBe taking frequent car rides/trips with usBe boarded when we go on vacationStay with family when we go on vacationBe given away to someone else if we feel it's not a good match for usBe turned in to a shelter if we can't keep itBe going camping with usBe going on boat trips with usBe outside with a dog house in a fenced areaBe outside chained/tethered to a dog houseBe free roaming on the farm (unfenced)Other
Please take time to think, be honest with yourself and us when answering this question. What are you absolutely NOT willing to deal with at the time of adoption or at any time during the life of the animal?*

HousebreakingChewingJumpingPulling on leash during walksCounter surfingObedience trainingFear of menFear of womenFear of childrenMouthiness (may sometimes snag your hand or arm instead of the toy in play and will need redirection/training)GrowlingBarkingRough play with my dogHigh activity levelFood/toy aggression/not willing to share with other dogsFood/toy aggression with peopleWhining/cryingCounter surfingBlindnessLimited SightDeafnessSeparation AnxietyDiabetesSpecial DietLong Term MedicationIncontinence / Leaking UrineTaking classes with the dogGets stressed/carsick when riding in vehicleDoesn't know how to climb stairsCan't climb stairs due to age/arthritis/health issuesHeart conditionSkin allergiesFood allergiesTrimming nailsYeast on coat or in earsEar mitesFleasTicksHeartworm preventativeAnnual heartworm/lyme combo testingI will do whatever it takes to help this dog adjust and work with a trainer to help resolve any training needs.Other
What would cause you to return an animal?*
What do you feel is a reasonable amount of time for an animal to adjust to life with you/your family?*
How do you plan to integrate this pet into your family?*
What would you do if you discovered after adoption (at any time during the life of the animal) if your vet diagnosed an expensive health condition?*
What brand of pet food do you plan to feed?*
Grooming (please check all that apply)*

We use a professional groomerWe trim nails ourselves at homeWe bathe our pets at home once a weekWe bathe our pets at home once a monthWe bathe our pets at home once every few months or whenever their coat feels dirtyWe bathe our pet twice a yearWe don't bathe our petWe check ears weekly for infection/yeast/mitesWe check coat daily for ticks in spring/summer/fallWe clean teeth using home methodsWe take our pets to the vet for dentals whenever the vet recommends this is neededPrefer an animal that doesn't shedDon't care about shedding
How long have you been looking for a pet?*
Do you plan to take formal obedience classes?*

YesNo
Additional reference (if desired)
Do you have any additional comments, questions or concerns? Anything else you would like us to know to help match you up to a pet?*
I understand that completing this application does not guarantee I will be allowed to adopt an animal, and that the application is a tool to help Big Heart Animal Rescue determine if this dog and my family are a good fit for each other. I acknowledge that all information provided on this form is true and correct. I understand that any misrepresentations may result in my not being approved and/or removal of the adopted dog from my possession. I also certify that I have never been convicted of animal cruelty or neglect.

I agree to allow a representative from Big Heart Animal Rescue to contact my vet for a reference and also agree to allowing a home visit prior to adopting this animal. If I am approved to adopt an animal, I agree to pay a non-refundable adoption fee and hand sign an adoption contract at the time of adoption.

I understand that all animals adopted from Big Heart Animal Rescue will be spayed/neutered, heartworm tested, fecal tested, and vaccinated prior to adoption.

I understand that if I can no longer care for the animal, I will contact Big Heart Animal Rescue to assist in finding the animal a new home.
Please read the above, check this box, sign, and click Submit.*

I/We have read and understand all of the above.
Applicant's Signature*
If you are unable to produce an electronic signature, please type your full name. In doing so, you acknowledge it to represent your signature.
Co-Applicant's Signature
If you are unable to produce an electronic signature, please type your full name. In doing so, you acknowledge it to represent your signature.
Signature date*
Renters: Please send a copy of the pet section of your lease or a landlord pet permission letter to admin@bigheartanimalrescue.com. Big Heart Animal Rescue reserves the right to reject any application based on information obtained during this screening process. Please understand that our primary goal is the health, happiness, and safety of our rescued animals.
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Big Heart Animal Rescue Adoption Application