HART Adoption Application

Name of the dog(s) you are applying for.*
Type "undecided" if not sure yet.
Adoption Application

Please answer questions thoroughly and honestly so that we can help guide you toward choosing a dog that is a match to your lifestyle. All applicants must be 21 years or older to adopt from Animal Aid of Mississippi. False or missing information will be cause for rejection or void of adoption contract. Please note that completing this application does not commit you to adopting the dog for which you are applying. It serves as a springboard for further conversation on the suitability for your family to adopt a dog within the Animal Aid of Mississippi criteria. INCOMPLETE APPLICATIONS WILL NOT REACH US.
Today's Date*

MonthDayYear
Date
What is your age? (You will be required to show ID to verify)*
Contact Information
Your Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Name and Address*
About The Adopter
Are you:*

a studentemployed (work outside the home)employed (work at home)unemployedhomemakerOther
How did you first learn about the dog you are interested in and/or Animal Aid of Mississippi?*

A friend/familyFacebookWebsitePetfinderOther
Where will the Dog sleep? (Check all that apply)*

In a Dog BedOutsideIn my bedWith another family memberIn a crateOn a couchOther
What is your reason for wanting to adopt a dog? (Check all that apply)*

Companion for myselfCompanion for Child or Family MemberMy pet died recentlyCompanion for another petEmotional support/service animalChange in living situation that allows pets nowOther
Housing
Do you live in a*

HouseApartmentStudioCondo/DuplexMobile/Manufactured homeRural/FarmStudent HousingOther
The traffic on my street is:*

HeavyModerateLightOther
In regards to your living space, please check one:*

I own my homeI rent my homeI live in a friend/family member's houseOther
If you are renting, are you permitted to have a Dog on the property?:*

YesNoN/AOther
Landlord Name*
Landlord Phone or Email*
Have you ever needed to rehome a pet?*

YesNo
Home Environment and Other Pets
List name and ages of all people in your home:*
(example: Susan, 44, John 43, Sophie 9)
Tell us about your other CURRENT pets and their spay/neuter status: *
(example: Pet 1. Male Dog, Dalmation, age 13, likes cats, energetic)
Are your current pets up to date on vaccinations and Heartworm Prevention?

YesNo
Tell us about your pets owned over the last 5 YEARS that are no longer with you: *
(example: Pet 1. Male Dog, Dalmation, age 13, likes cats, energetic)
Do you have a current or prior veterinarian? Please write their name and contact information.*
Have you ever had to rehome a pet? If yes, please explain the circumstances.*
Choose which options most often describe your home:*

QuietBusy/NoisyPeople away most of the day.People home most of the time.
Is anyone living in your home allergic to Dogs?*

YesNoOther
Care of Your New Dog
How long, on average, will your Dog be alone during the day and where will he/she be kept during this time? (ex: Garage, crate, bedroom, outdoors, free roam inside, free roam outside, etc) *
What is your exercise plan for your Dog? *
Do you have a fenced yard? Please describe the containment, if any. *
If you are on vacation, or away from home for more than 12 hours, who will care for your Dog?*

Family/Friend/NeighborPet SitterBoarding/KennelsCat will be self sufficientOther
Will your Dog be:*

Indoors onlyOutdoors onlyIndoor/outdoor with Dog DoorOther
Where will your Dog be kept during the day? (ex: Garage, crate, bedroom, outdoors, free roam inside, free roam outside, etc) *
Where will your Dog sleep at night? (ex: Garage, bedroom, outdoors, free roam inside, free roam outside, etc) *
All Dogs shed hair to some extent. How much shedding is acceptable?*

LightModerateDoesn't Matter
My ideal Dog will:*

Frequently interact with kids.Frequently interact with small animals.Frequently interact with cats.Frequently interact with other Dogs.Frequently interact with strangers
Which behaviors would be unacceptable and cause for you to rehome the Dog?

Needs social skills.Accidents in the house.Inappropriate chewing.DiggingSeparation anxietyJumpingFighting with other petsToo much/too little energyOther
Where will your Dog be kept during the day? (ex: Garage, crate, bedroom, outdoors, free roam inside, free roam outside, etc) *
In the event that you become incapacitated (ex: inability, illness, injury, death), please explain your care plan for this Dog. *
If the Dog you are applying for is adopted by someone else, are you interest in speaking with our team about other dogs we have available for adoption? Please describe your "ideal dog."
Thank you for applying.

Your Adoption Application will be reviewed by an Animal Aid Of Mississippi volunteer. Animal Aid reserves the right to deny this application per our discretion. Identification is required during the process of this application. This application becomes part of our Adoption Contract. This adoption application does not commit the applicant unless or until this application becomes an adoption contract.
By signing this application, I hereby certify that the above information is true. I understand that giving false information on this application is grounds for denying my application and voiding any adoption contract. I certify that the dog I am applying for is for me and not for another person. I agree to have all of the information on this document verified and agree to allow Animal Aid of Mississippi to contact my veterinarian, references, and/or landlord, if applicable.*

I agree.
Signature*
Type a question
Should be Empty:

Adoption Application

Contact Information

About The Adopter

Housing

Home Environment and Other Pets

Care of Your New Dog

Thank you for applying.