Hope4Hearts Adoption Application

Thank you for choosing to adopt! Our adoption fee is $175. Completion of this adoption application does not guarantee approval. Your application will be reviewed by our adoption committee and may be rejected for any reason. Prior to approval of your application, a home visit will be conducted by a member of our adoption committee to ensure your home is a safe and loving environment for the animal. *You must be at least 21 years of age and live within a 100 mile radius of Mobile to adopt.*

Name of the animal you want to adopt

Applicant's name*

First NameLast Name

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Primary Contact Number*

Area CodePhone Number

Is the primary contact number a

Home phoneCell phoneWork phone

Alternate Contact Number

Area CodePhone Number

Do you own or rent your home?*

OwnRent

Is your home a*

Single family homeTownhouse or apartmentOther

If you rent, are there any restrictions related to pets? If yes, please check all that apply.

Breed restrictionSize/weight limitRestrictions on number of pets allowed

Please describe any restrictions checked above.

Landlord's name (if applicable)

First NameLast Name

Landlord's phone number (if applicable)

Area CodePhone Number

By providing your Landlord's information, you understand and agree that a volunteer from Hope4Hearts will be contacting your Landlord to verify the information provided. Please notify your Landlord so he/she will expect our call and will provide the requested information.

Do you have a fenced yard?*

YesNo

If yes, please describe your fence*

If you do not have a fenced yard, please describe your plan to ensure your new pet gets enough daily exercise.

How many people live in your home?*

Please list the names and ages of any children who live in the home at least 30% of the time

Please describe your household so we can make sure that the animal you wish to adopt is a good fit for you and/or your family. Are you/your family active, average, noisy, quiet, etc.?

Where would your pet be kept when no one is at home?*

How long would your pet be left alone each day?*

Where would your pet be kept at night?*

Do you currently have any other pets?*

YesNo

Pet #1 (Age, gender, breed, approximate weight)

Is Pet #1 spayed or neutered?

Is Pet #1 up-to-date on vaccinations?

Pet #2 (Age, gender, breed, approximate weight)

Is Pet #2 spayed or neutered?

Is Pet #2 up-to-date on vaccinations?

Pet #3 (Age, gender, breed, approximate weight)

Is Pet #3 spayed or neutered?

Is Pet #3 up-to-date on vaccinations

Describe any additional pets

Are your pets currently on monthly heartworm preventative?

YesNo

Have you had any other pets in the last ten (10) years? If so, where are those pets now?*

Please provide the name, address, and telephone number of your veterinarian and the name under which the records are kept.

A volunteer will be contacting your veterinarian to confirm all of the information provided. Please let them know that they have your permission to provide the information to a volunteer with Hope4Hearts.

Please provide the name and telephone number of two (2) personal references.

Additional comments or questions

By submitting this application, you understand and agree that if for any reason you are unable to keep or continue to care for the animal you want to adopt, he/she MUST be surrendered back to Hope4Hearts.