Please fill out all questions to the very best of your ability. If there's something you feel you cannot answer here, don't fret, we'll cover it in the in person interview. Please note that EVERY applicant is subject to a background check, home check and in person interview before adoption will be approved.

  1. Please provide the following contact information:
    First name
    Last name
    Middle initial
    Title
    Street address
    Address (cont.)
    City
    State/Province
    Zip/Postal code
    Country
    Work Phone
    Home Phone
    FAX
    E-mail
  2. Please identify and describe yourself: (Please list your driver's license or Social Security Number for ID.
    Date of birth
    Sex Male Female
    Height
    ID number
    Hair color
    Eye color
  3. Please write the name of the animal or animals you wish to adopt in the space provided below.


  4. This animal is a:

    male
    female
    cat
    dog
    ferret
    horse
    other

  5. Please choose the option that best describes your living arrangements:

    I rent
    I own my home
    I live with family
    I live with friends

  6. If you rent, please provide the following contact information for your Landlord/Lady: (Permission MUST be given by the property owner to keep the animal!)
    Name
    Title
    Organization
    Street address
    Address (cont.)
    City
    State/Province
    Zip/Postal code
    Country
    Work Phone
    Home Phone
    FAX
    E-mail
  7. If you own, how many years have you lived at this address ?


  8. How many people are living with you?


  9. If applicable, please list the names, gender and ages of all the people living in your household.


  10. Please enter your occupation in the space provided below.


  11. How long have you been employed there?


  12. Can we contact your employer?

    Yes No

  13. Please provide your marital status:


  14. Who wil be the primary caretaker for this animal?


  15. Please provide the following contact information for the Veterinarian you will use to care for this animal:
    Name
    Title
    Organization
    Street address
    Address (cont.)
    City
    State/Province
    Zip/Postal code
    Country
    Work Phone
    FAX
    E-mail
    URL
  16. Do you have any other animals living with you?

    Yes No

  17. If yes, please list all the animals living with you by name, age, sex, species and breed, how long you've had each animal, and whether they live inside or outside.


  18. Please list your reasons for deciding to adopt this animal at this time:


  19. Have you had experience with this Breed of animal before?

    Yes No

  20. Are you open to taking a few classes with this animal if suggested?

    Yes No

  21. On average, how many hours a day do you feel you have to spend with this animal?


  22. Where will the animal be when you are not at home? Select any that apply:

    Home alone
    In Boarding
    With a sitter
    At home with family
    Outside at home
    Crated

  23. Do you have a fenced in yard?

    Yes No

  24. If not, how will you exercise this animal? Select any of the following options that apply:

    Personal walks
    Doggy Daycare
    Play dates
    Dog Park

  25. What do you think is the best way to discipline an animal?


  26. Have you ever been convicted of a crime?

    Yes No

  27. Do you give us permission to do a background check on you and ayone living with you ?

    Yes No

  28. Please provide at least five references from those unrelated to and not living with you:
    Name
    Title
    Organization
    Street address
    Address (cont.)
    City
    State/Province
    Zip/Postal code
    Country
    Work Phone
    Home Phone
    FAX
    E-mail
    URL
  29. Reference #2:
    Name
    Title
    Organization
    Street address
    Address (cont.)
    City
    State/Province
    Zip/Postal code
    Country
    Work Phone
    Home Phone
    FAX
    E-mail
    URL
  30. Reference #3:
    Name
    Title
    Organization
    Street address
    Address (cont.)
    City
    State/Province
    Zip/Postal code
    Country
    Work Phone
    Home Phone
    FAX
    E-mail
    URL
  31. Reference #4:
    Name
    Title
    Organization
    Street address
    Address (cont.)
    City
    State/Province
    Zip/Postal code
    Country
    Work Phone
    Home Phone
    FAX
    E-mail
    URL
  32. Reference #5:
    Name
    Title
    Organization
    Street address
    Address (cont.)
    City
    State/Province
    Zip/Postal code
    Country
    Work Phone
    Home Phone
    FAX
    E-mail
    URL
  33. Please let us know the best time to call you for an interview and at what number:


© HHARTS™ 2007
Last revised: February 13, 2008