Adoption Application

Adoption Application

Thank you for applying to adopt a rescue dog! Please answer all questions, and allow 2 full weeks for review. If you do not hear back from us after 2 weeks, email us at caringheartscanine@gmail.com. If you do not have a dog in mind, you can send the application in to have on file, and when you see a dog you are interested in email us to check availability. If available, we can proceed with the adoption approval process. Please note, that email is our primary source of communication. PLEASE ANSWER ALL QUESTIONS. Thank you!
Dog Name or Application on file *
Applicant Name*

First NameLast Name
Applicant Email*
example@example.com
Date of Birth

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
State Drivers License Number*
Due to North Carolina law, Caring Hearts for Canines is required to have a copy of the state ID card or the adopters drivers license number. It can be an out of state number or ID. Please email us the ID card, if there is no license.
Home Phone Number
Cell Phone Number*
Do you text?*

YesNo
Have you adopted a pet from a rescue before?*

YesNo
If Yes, what was the pet's name and from which rescue?
Reference

Please provide a personal Reference, the reference should not be a relative or spouse.
Personal Reference (Not Related)*
Name
Personal Reference Phone Number*
Do they text?*

YesNo
Relationship*
Best time to contact
Applicant Employer Information
Are you currently*

EmployedUnemployedStay at home parentRetiredStudentOther
If you are employed, where do you work?
How long have you been working there?
If you are unemployed, how will you pay for the pet?
If you are a student, where are you enrolled, when will you graduate and what will happen to the pet when you graduate?
Co-Applicant:

If you have a spouse/partner, please list as co-applicant.
Co- Applicant Name: If you have a spouse/partner, please list as co-applicant.

First NameLast Name
Co- Applicant Email
example@example.com
Relationship
Cell Phone Number
Do they text?

YesNo
Are they currently

EmployedUnemployedStay at home parentRetiredStudentOther
Name of Co- Applicant Employer or School
Household Information
Type of Residence*

HouseApartmentTownhomeCondoMobile HomeFarmLiving with FamilyOther
Do you*

OwnRent
If you rent, are animals accepted, are there size/breed restrictions?
Landlord/Complex Name
Landlord/Complex Phone Number
Do they text

YesNo
Type of Area*

CitySuburbanCountry/RuralBeach/LakefrontOther
Type of Street Traffic*

Busy RoadModerate TrafficSlight TrafficOnly homeowner trafficApartment Complex Parking LotOther
Will you be moving within the next 6 months? If yes, where?
Number of all people in household*
Ages of children
Is anyone in the house allergic to animals? If yes, please explain. *
Do you have a yard, if so how big is it?*
If your yard fenced, what type of fence and how tall?
Do you have a pool?*

Yes, In GroundYes, Above GroundNo Pool
If yes, is the pool fenced separately from yard?*

YesNoNo Pool
Caring for Your New Pet
Why do you want to rescue a pet? For example companionship, protection or service dog?*
Where will your pet live, inside or outside? If outside please explain. *
Where will your pet sleep?*
If your yard is not fenced, how do you plan on exercising and walking the dog? Will your pet be allowed off-leash, if so where?
How many hours will your pet be alone?*
Do you have a pet door?*

YesNo
Where will the pet stay when left alone?*
Describe the activity level in your house, for example busy with children, or quiet with a few guests*
In the absence of the primary care giver, who will care for the pet?*
What vet clinic do you use? If you do not have a vet, say No Vet*
Vet Clinic Phone Number
I give permission to Caring Hearts for Canines to access our vet records and the given vet offices.*

I agreeNo Vet
What brand of food will you be using?*
Will you be considering obedience training?*
What are your anticipated costs per year for the pet including vetting, grooming, food, toys, etc.?*
If the pet has difficulty adjusting to the new living situation, how will you handle it? Please explain.*
Are you willing to take responsibility of the pet if he/she acquires any illness, needs surgery or is diagnosed with any other health issue be it chronic, terminal or any form, for example Heartworm.*

YesNo
What Heartworm and Flea/Tick preventative do you plan on using? If you do not use any, please explain.*
Have you ever had to re-home a pet or place a pet in a shelter? If yes, please explain.
Under what circumstances would you return the pet?

New JobDivorceNew BabyAllergiesMovingPet Health IssuesHousebreaking IssuesToo Time ConsumingBehavioral IssuesOther
Past & Current Pet Information
Have you had pets in the past 10 years? If so, please list below. Please list recently passed pets as well*

Yes, below are my current and past petsI have never had petsI have had pets, but not within the last 10 yearsNo, but I live with other people's pets

Please list current and past pets in the last 10 years

	Name	Species	Breed	Age	Spay/Neuter	Where is your pet now?	Over the Rainbow Bridge
Animal
Animal
Animal
Animal
Animal
Animal
Animal

Are you applying to any other rescue organizations? If so which ones?
Please write down any notes or anything you feel would be good for us to understand about yourself and/or your family.
Adoption Contract

PLEASE READ CAREFULLY, AND UNDERSTAND THE TERMS AND CONDITIONS BEFORE CHECKING THE BOX. CARING HEARTS FOR CANINES RESERVES THE RIGHT TO TAKE AWAY APPROVAL STATUS IF THE APPLICANT BECOMES DIFFICULT OR UNSAFE.
Please Read: For all of our adopters, please remember that often the dogs we rescue come from difficult situations, often neglected or living on their own. Caring Hearts for Canines does not guarantee any dog that is adopted is house broken. Caring Hearts for Canines does not guarantee what size a puppy will be or what breed a dog is. Please also remember, that puppies that are treated for worms or parasites will need a follow up appointment which is the responsibility of the adopter, to ensure the worms and parasites have been killed.

I have read this, and understand.
By clicking below, I agree that all the above statements are true.*

I Agree, All Above Statements are True
By clicking below, I agree to PAY THE NON REFUNDABLE ADOPTION FEE*

I Agree
By clicking below, I agree to, MAKING SURE THE ADOPTED PET IS WEARING A COLLAR OR HARNESS AT ALL TIMES WTH IDENTIFICATION.*

I Agree
Please verify that you are dog loving human*
THANK YOU FOR APPLYING FOR A DOG!

IF YOU NEED TO RETURN A DOG ADOPTED FROM CARING HEARTS FOR CANINES, PLEASE EMAIL CARINGHEARTSCANINE@GMAIL.COM.
Caring Hearts for Canines

PO Box 1219

Southern Pines, North Carolina 28388

www.caringheartsforcanines.com

CARING HEARTS FOR CANINES IS A 501C3, ALL DONATIONS ARE TAX DEDUCTIBLE
Should be Empty:

Adoption Application

Reference

Applicant Employer Information

Co-Applicant:

Household Information

Caring for Your New Pet

Past & Current Pet Information

Adoption Contract

THANK YOU FOR APPLYING FOR A DOG!