Trailways to Heaven Animal Rescue
Adoption Application
Name of adopter
*
First Name
Last Name
Dog’s name
*
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Date of Birth
*
-
Month
-
Day
Year
Date
Employer name/address/phone number
*
Occupation
*
Type of home you live in
*
House
Townhouse/Condominium
Apartment
Do you own or rent your home?
*
Own
Rent
Landlord’s name and contact information (if you rent):
*
Do you have a fenced in yard?
*
Yes
No
If so, what height is your fence?
*
Does your gate have a lock?
*
Yes
No
How will you exercise the dog?
*
Who will walk the dog / take the dog out?
*
How often will the dog go outside?
*
What type of vehicle do you own and how will the dog be transported?
*
I am adopting this dog for
*
Myself
Spouse
Other
Please tell us why you want to adopt a dog
*
Number of people living in the home:
*
Number of people who are under 21 and their ages:
*
Please list all the people your dog will be living with, their relationship, and ages
*
Does anyone living in the home have allergies to animals?
*
Will the whole family share in the care of this dog?
*
Are you planning to move in the next 12 months?
*
What will happen to this dog if you move unexpectedly?
*
What will happen to this dog if you go on vacation or in case of an emergency?
*
How many hours during the average day will your dog be without a human?
*
Where will you keep this dog when no one is home?
*
Do you want this dog to be
*
Inside only
Outside only
Both
Please list all other pets living with you, their breeds and ages:
*
All other animals living in the home are up to date on their rabies vaccination and I agree to provide current vaccination records for any other animals living in the home
*
Yes
No
All other animals living in my home are spayed or neutered and I will provide proof of spay/neuter upon request
*
Yes
No
Veterinarian Reference: Please provide the name, address and phone number for the vet that can provide the spay/neuter and vaccination status of your current or recent pets
*
How often do you feel a dog should see a veterinarian?
*
Please tell us what you know about heartworms
*
I agree to provide a monthly heartworm preventative and yearly heartworm test for this dog
*
Yes
No
What type of flea and tick preventative do you plan on using for this dog?
*
Please list the size and breed preference and qualities in a dog that would best suit your home
*
What will you feed your new dog?
*
What kind of behavior do you find unacceptable in dogs?
*
If the dog has problems with behavior what will you do about it?
*
First personal reference (name, phone number, email)
*
Second personal reference (name, phone number, email)
*
I understand that completing this application does not guarantee approval for adoption of any animal and that Trailways to Heaven has the right to refuse any adoption at their discretion
*
Yes
No
I understand that attending a meet and greet does not mean that I am approved to adopt that animal and that some animals may require multiple visits before they are ready to go home with an adoptive family. I understand that all rescue animals have their own unique personalities and different needs and that circumstances can and do change at times.
*
Yes
No
I agree that unless directed by a licensed veterinarian for reasons related to the health and welfare of the animal, cosmetic surgery will not be performed under any circumstances, including but not limited to tail docking, or ear cropping
*
Yes
No
I understand that if I can no longer care for this dog I will immediately contact and return the dog to Trailways to Heaven Animal Rescue. I will not surrender the dog to an animal shelter or another animal rescue. I will not abandon, sell, rehome or give the dog away. I will not euthanize or have a veterinarian euthanize the dog for any behavioral issues or any reason other than terminal illness or injury.
*
Yes
No
If I am returning this dog, I agree to allow 7 days after notifiying Trailways to Heaven, for them to arrange transportation for the dog. I may also personally bring the dog to the rescue at 589 Old Tioga Turnpike, Benton PA 17814.
*
Yes
No
I understand that if I return the dog within 14 days of adoption I will receive a refund of my adoption fee minus 25%. If I return the dog after 14 days I will not receive a refund of my adoption fee.
*
Yes
No
I HAVE ANSWERED ALL QUESTIONS AND PROVIDED ALL REFERENCES TRUTHFULLY AND HONESTLY TO THE BEST OF MY KNOWLEDGE. I certify that the above information is true and understand that false information will result in nullifying this adoption.
Yes
No
Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: