Hopeful Hearts Rescue Dog Adoption Application

Hopeful Hearts Rescue Dog Adoption Application
This questionnaire is designed to help Hopeful Hearts Rescue and yourself determine if a specific dog is the right one for you and your household. These questions give us an idea about you as a pet owner and help us match you with the right companion. No specific answer is disqualifying, so please be honest so we can best help you.

Hopeful Hearts Rescue reserves the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoptions.
Personal Information
Full Name

First NameLast Name
Former Names or Aliases
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is your mailing address different from your home address?
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Are you at least 21 years of age?

Reference Information

Non-family references help us better understand your lifestyle, experience, and readiness to care for an adopted dog from an outside perspective.

Please provide two non-family references

Rows	Name	Relationship to Reference Person	Phone Number	I have informed reference that a Hopeful Hearts Rescue Representative will be calling to complete reference check.
Reference 1
Reference 2

Landlord Information (for renters only)
Landlord's Name

First NameLast Name
Landlord's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Please list all current animals under your ownership.

If you have any other pets that do not fit on the table above, please provide additional pet information in the space below.
Do you have any other animals at your residence that are not legally under your ownership (ex. a friend or family member's pet)?
If yes, please explain the circumstances and whether or not these animals are up to date on shots.

Please list all animals you have owned in the past 5 years.

If you have any other pets that do not fit on the table, please provide additional pet information below.
Have you ever given up an animal?
If yes, please explain the circumstances that lead to giving up the animal.

Veterinary Reference Information

Please provide the following information for your current veterinarian. If you do not have a veterinarian currently, please leave these fields blank.
Full Name of Veterinarian

First NameLast Name
Veterinary Practice Name
Veterinarian Practice Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Veterinarian Practice Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
I will contact my veterinarian to confirm they are authorized to release my records and information to a Hopeful Hearts Rescue representative for the purpose of completing my reference check.
Is this the vet you intent to take your newly adopted dog to?
Please provide the veterinarian (full name) and veterinary practice (name, address, phone number) you plan to use for your adopted dog. If you haven’t chosen one yet, we’re happy to help you find veterinary care options.

New Pet Information
List the name(s) of the dog(s) you are interested in adopting.
We'd love to know what led you to apply for adopting a dog, and what are you hoping this new companion will bring to your life?
What type of personality/activity level are you hoping your adopted dog will have (ex. calm, couch potato, energetic, protective, playful, etc.)?
Where will the dog primarily live?
Where will the dog sleep at night?
What will you do with the dog while you are on vacation?
Roughly how many hours a day will this dog be left alone? Where will the dog be during these hours?
How will you exercise the dog?
Please describe how the dog will be contained/supervised when outside your home (fencing, leash, yard setup, supervision, etc.).
If, for some reason, you are unable to keep this dog, what would you do with him/her?
Do you anticipate being able to financially provide for this dog for the duration of his/her lifetime?
What would you do with your adopted dog if you were unable to financially afford caring for him/her?

Additional Information
How did you hear about Hopeful Hearts Rescue?

Other
Tell us anything else you want to about yourself and/or your family that would help us match you with the right pet. We would love to hear about your lifestyle, activity levels, hobbies, etc.
Should be Empty:

Personal Information