I am interested in
Species
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ATTENTION: This application is not for dogs.
What makes you interested in adopting/fostering this particular pet?
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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
Home Phone
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(###)
###
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Cell Phone
(###)
###
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Are you 18+ years old?
Where do you live?
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How long have you lived at your current address? (Years, Months)
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Do you own or rent your home?
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Current Pets
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Are Current Pets Spayed/Neutered?
Previous Pets
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Do you have a cage or pen for your pet?
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What are the dimensions of your cage or pen?
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Please include all dimensions - length, width and height. Be sure to include number of levels, if applicable.
Does the cage or pen have a wire bottom?
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Who will be responsible for the care of this pet?
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Name/relationship/age
Where will this pet stay in your house?
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If you move are you willing to take your pet with you?
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If you go on vacation or have an emergency, who will care for your pet?
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Do you ever plan on allowing the small pet outside?
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Does anyone in your house suffer from asthma or allergies?
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If yes, please identify the allergen.
Please list all people who reside in your house.
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Please list name, age, & relationship.
Veterinarian
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Please list vet clinic, location, names of pets treated there, and name they were treated under.
Vet's Phone Number
(###)
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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.
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.
Have you ever owned a rescue animal?
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What reasons do you feel are acceptable for returning a rescued pet?
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Have you ever turned an animal into the shelter?
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If yes, please explain:
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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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Where did you hear about this pet?
If other, from where?
