EmailMe Form - Rescued Hearts Northwest - DOGS

Rescued Hearts Northwest - DOGS

DOG ADOPTION APPLICATION

NOTE: Submitting this application does not obligate the applicant to adopt an animal, nor does it obligate RHN to approve the applicant.
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Your Name
First Last
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Best phone number to reach you (please provide extension if applicable).
Best time to call:
Email *
Would you like to opt in to our newsletter? (We will use your email ONLY for Rescued Hearts Northwest purposes: to let you know about RHN news, volunteer and foster opportunities, events, and of course adoptable pets.)
Which pet you are interested in?
What life stage are you interested in? (check all that apply) *
Baby (7 weeks – 18 months)
Adult (19 months – 8 years
Senior (9 years +)
What breed(s) are you interested in?
I want this pet for the following reasons. (Check all that apply) *
As a companion for myself
As a guardian
For a relative or friend
For my spouse
For my children
As a gift
How many children live in your home? *
No children
Number of children:
What are their ages? *
No children
Childrens' ages:
Do they have experience with animals? *
Yes
No
No children
If Yes, please describe. *
No children
Childrens' experience with animals:
What hours are you or someone usually home? Please be specific *
Please select the answer which best describes your living situation: *
House
In a relative or friend's home
Condo
Mobile home
Apartment
Duplex or fourplex
Townhouse
** Approval for a pet by the property owner must be verified. If you rent, we will contact your landlord. WE MUST HAVE YOUR LANDLORD'S NAME AND CONTACT INFORMATION ON THIS APPLICATION **
Do you rent or own your residence? *
Rent
Own
Landlord's Name
First Last
Landlord's Phone Number
### - ### - ####
Landlord's Email
If you rent, does your lease allow pets? *
If you rent, do you have a monthly or yearly lease? *
If you rent, when does your lease expire? *
I am the property owner
Lease expiration date:
How long have you lived at your current address? *
Do you have a yard? *
Yes
No
Yard size:
Small
Medium
Large
Acreage (how many?)
Is the yard fenced? *
Yes
No
If fenced, what type of fencing? (E.g. wood, small-gauge wire, poultry fencing, chain link, locking gate, secure entry, etc.) Please be specific. *
No fence
Fence description
If fenced, how tall is the fence? *
No fence
Fence height:
Are you a student? *
Full-time
Part-time
No
How will this pet be exercised, and how often? *
Where will this pet be kept when no one is home? *
Inside house
Inside, garage
Outside, tethered
Inside house, in crate
Outside, in fenced yard
Outside, in a run
Do you have a dog door? *
Yes
No
Where will this pet sleep? *
In the house, wherever the pet wants
In the house, in a crate
In the garage
In the garage, in a crate
Outside, in the yard
Outside, tethered
Do you have other pets (including farm animals)? *
Yes
No
If Yes, what kinds, and what are their breeds? *
No other pets
Brief description of other pets:
How many? *
No other pets
Number of animals:
What are their ages? *
No other pets
Animals' ages:
How long have you had them? *
No other pets
Duration of pet ownership:
Have you had a pet in your home and/or on your property die of a disease such as distemper, feline leukemia, or parvovirus? *
Yes
No
Not sure
No other pets
If Yes, when? *
No death from these illnesses
Time frame:
Are your other pets spayed and/or neutered? *
Yes
No
No other pets
If No, please explain why *
All my pets are spayed and/or neutered
No other pets
Reason for not spaying or neutering:
Do you feel you can afford the cost of maintaining this pet for his/her lifetime? *
Yes
No
What source of income do you have to make this happen? Check all that apply. *
Job
Public assistance
Other
Since most shelter animals have unknown medical/health backgrounds, are you prepared to provide and pay for any necessary medical treatment throughout this pet's lifetime? *
Yes
No
** A Vet Check is Required. We will contact your veterinarian **
Do you have a regular veterinarian? *
Yes
No
No other pets
If Yes, to which clinic do you take your pet(s)? *
No other pets
No veterinarian established
Veterinarian contact information:
If No, and you currently have pets, please explain why. *
No other pets
Reason for not having a regular veterinarian:
Is your veterinarian willing to spay/neuter this pet by 6 months of age? *
Yes
No
Need to verify
You're Almost Done!
Do you or any family members have allergies to pets? *
Yes
No
Who will be responsible for taking care of this pet? *
How will this pet be cared for when the primary caregiver is out of town? *
Do you have training experience? *
Yes
No
Have you attended formal obedience classes with a pet? *
Yes
No
If Yes, where? *
No formal obedience classes
Name of facility:
Are you familiar with local animal control ordinances for the area in which you reside? (A volunteer can provide you with local information regarding spay/neuter, licensing fees, etc.)
Yes
No
If something were to happen to the primary caregiver for this pet, is there a long-term care solution in place? Please describe. *
Would there ever be a reason you would give up this pet? *
Please explain why you want a pet at this time, in as many words as you need. THIS IS AN IMPORTANT PART OF YOUR APPLICATION! *
May we visit your home? *
Yes
No
VERIFICATION
By entering my name and the current date below, I certify that the information in this application is true and accurate to the best of my knowledge, and I understand that falsification of this information may be cause for denial of my application or revocation of an Adoption Agreement.

Full Name *
Today's Date *
MM / DD / YYYY