HCW Adoption Application

Date*

Date

1. First and Last Name*

Address*

Street Address

Street Address Line 2

CityState

Zip Code

E-mail address*

example@example.com

Home phone

Cell phone

Employer

Occupation

2. Spouse/Partner name

Cell phone

Employer

Occupation

3. Dog considering - Name of Dog

Breed

Adoption Fee $

4. Why do you want to adopt a dog?

5. Have you ever owned a dog before?

6. What pets do you currently own?

	Name of pet	Type (cat, dog..)	Breed	Age	Owned (Years)	Indoor or Outdoor
1
2
3
4
5

7. Veterinarian Reference Name

Location

Phone number

What name is on your veterinarian records?

Please contact your vet and give them permission to speak with us. This will save time processing your application.

8. Do/did you keep your dog on monthly heartworm prevention?

If yes, what brand?

Where do you purchase it?

9. What brand of dog food are you currently feeding? If you do not currently have a dog, list previous brand of food

10. Are ALL the pets you have spayed or neutered?

If not, why?

11. Please list the past pets you've had and explain what happened to them

	Name of pet	Type (cat, dog..)	Breed	Age	Owned (Years)	What happened?
1
2
3
4
5

12. Does everyone in your household know you are planning to adopt a dog?

13. Do you

Own your homeLive with parentsRent

If renting, house or apartment?

If renting, name and phone number of landlord

Other

14. Age and relationship of everyone in your household, including yourself

	Age	Relationship
Self
1
2
3
4

15. Do you have a fenced yard?

If so, what type of fence?

How high is the fence?

If you do not have a fence, how do you plan on confining your dog?

16. Have you ever given up a pet in the past?

If so, explain

17. Should you move unexpectedly, what will become of the dog?

18. What behaviors would you consider unacceptable in your dog?

19. Do you agree to keep your dog on a leash while off your property as required by local and state law?

20. Have you ever tied a dog out for any reason?

If so, please explain

21. How many hours a day will your dog be alone?

22. Where will the dog stay when alone?

23. Where will the dog sleep?

24. If you travel, how will your dog be cared for?

25. Will the dog be kept indoors or outdoors?

If outdoors, what kind of shelter will be available to protect the dog from the elements?

26. If your dog is not spayed/neutered on the date of adoption due to its age, will you have it spayed/neutered by its sixth month of age?

27. Do you agree to forfeit your spay/neuter deposit if terms of #26 are not met?

28. Are you prepared for the costs involved in properly caring for a dog (such as good quality food, regular check-ups, dentals, grooming, annual vaccinations, non-routine and emergency care, heartworm prevention, flea/tick control...)

29. All of the information I have provided is true and complete to the best of my knowledge. By initialing/clicking "I agree" button below, I agree to provide the dog with good quality food, water, monthly heartworm prevention, shelter, affection and medical care.

Failure to answer all questions completely will delay processing of your application.

Once this application is approved, a SITE VISIT of your home may be scheduled. If a site visit is not possible, three (3) letters of reference may be required, one of which must be from a veterinarian.

Thank you for visiting Heaven Can Wait Animal Rescue and Sanctuary. We appreciate your desire to welcome one of our very special friends into your home.

Terms outlined above*

I agreeI do not agree