I am looking to
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Name
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First Name
Last Name
Email Address
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Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Where do you live?
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Do you own or rent your home?
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Do you have homeowner's insurance?
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If Yes, who is your insurance provider?
Home Phone
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(###)
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Cell Phone
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Are you 18+ years old?
Please list all people who reside in your house.
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Who, besides you, resides in your home (name, age, relationship, and whether it is part or full-time)
Current Pets
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Please list your current animals (name, species, sex, breed, and age).
Are Current Pets Spayed/Neutered?
If they are not spayed/neutered, why not?
What pets have you owned in the last 5 years?
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Please list all your animals you have owned in the last 5 years, not including current animals) (name, species, breed, sex, age and where they are now)
Are your current dogs on Heartworm preventative?
Veterinarian
Veterinarian used for your pet(s) (if you do not currently have pets, please list the vet used for your previous pets). List name of clinic, phone number, address, name(s) of pets treated here, and name the account is under. Some vets require you to release your records to Heartland; please call your vet and advise them a representative from Heartland will be calling to check on the vetting status of your pets.
Vet's Phone Number
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Have you ever turned a pet into a shelter?
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If you have turned a pet into a shelter, please explain why.
Please describe your yard.
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Approximate size, fenced or not. Having a fenced in yard is not a requirement.
Where will this pet be kept when home alone?
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Crate, specific room, free roam of the house, etc.
Will this pet be primarily an indoor or outdoor dog?
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How long will your pet be left alone daily?
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How will your dog be let out for bathroom breaks/exercise?
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Tie out, run, fenced yard, kennel, unsupervised, etc.
How much are you willing to spend on vet care annually for this pet? What will you do if the bill goes over this amount?
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Who will be responsible for the care/training of this pet?
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Where will your pet sleep at night?
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If you move, are you willing to take your pet with you?
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Do you agree to allow a Heartland representative to perform a home visit before and after adoption?
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A home visit is not required for all adoptions, but may be requested at any point after adoption.
If you go on vacation or have an emergency, who will care for your pet?
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What provisions would you be willing to make for your pet should you become unable to care for it?
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Under what circumstances would you consider turning a pet over to a shelter?
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What behavior characteristics in your dog are important to you?
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What are your goals for owning this dog?
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What is the lifestyle you are expecting your dog to adapt to?
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How did you hear about this pet?
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If other, where?
Please provide a personal reference:
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This can be a friend, family member, employer or member of the clergy. Be sure to include name, address and phone number.
