SAVING ANIMALS LIVES...THE HEART OF WHAT WE DO
Help HEART place unadoptable rescue cats in safe, warm barn environments.
HEART has another location in the Northtowns ~ 4219 Transit Road, Williamsville ~ Monday - Saturday ~ 12:00pm - 6:00pm.........Please Help. Huge Kitten and Cat Influx Has Created a Most Urgent Need for Volunteers, Foster Homes and Forever Homes.
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Adoption Application (Dog)
First Name
Last Name
Address
City
State
Zip
Phone
Email
Age
(Must be 21 years of age or older)
How many adults are in the home?
How many children?
Children's Ages?
If no children, are you expecting a child at present or planning to have children join your family in the future
Yes
No
Is anyone residing in your home opposed to your adoption of a dog?
Yes
No
Don't know
Does anyone in your household have an allergy to dogs?
Yes
No
What type of home do you live in?
Single Family
Apartment
Town House
Farm
Do you own or rent your home?
Own
Rent
Briefly describe location of home on property and proximity to street?
Is your yard fenced in?
Yes
No
Do you have a pool?
Yes
No
Is there a chance you will be relocating in the near future?
Yes
No
Do you have other pets?
Yes
No If yes, what kind?
Are they current on vaccines?
Yes
No
Are they spay/neutered?
Yes
No If not, why?
Have you ever surrendered a pet to a shelter or given a pet away?
Yes
No If yes, what were the circumstances?
Have you ever lost a pet to an accident?
Yes
No
Have you ever had a pet euthanized?
Yes
No If yes, what were the circumstances?
Do you have a regular Veterinarian?
Yes
No
Veterinarian's Name
Phone
(By providing HEART with this information, you are allowing HEART to contact your Veterinarian as a reference. Please contact your vet and ask them to authorize the release of information to HEART)
Have you already seen a HEART dog that you are interested in adopting?
Yes
No If yes, who?
Where did you see this dog
Who will have primary responsibility for the dog's daily care?
Do you agree to keep the dog as an indoor dog?
Yes
No
Where will the dog be kept when home alone?
What is the average number of hours the dog will be alone each day?
How will the dog be supervised when outdoors?
Do you agree to regular health care by a Licensed Veterinarian?
Yes
No
Are you willing to let HEART representative visit your home by appointment?
Yes
No
Are you willing to take responsibility for this dog for the next 10 to 20 years?
Yes
No
I certify that I have read this questionnaire and that the information I have given is true and accurate, and I understand that any falsification may result in the nullification of this adoption.
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