H A R T Foundation - Application

Application for Amy's Dogs
Please make sure that you complete all of the spaces below. Once you have completed "ALL" the spaces click on the "SUBMIT" button at the bottom of the screen.

It is very important that you answer all the questions honestly to help us to know you better and to help with finding the best dog for you.

You must be 18 years old or older in order to adopt one of our rescue pets.

Payment to be made by CASH ONLY.

Important Note: If you are not serious about adopting please do not waste our time.

Please note that if your application will not submit, it may be because you have not completed all the required information on the application.
Name of Dog Interested in:
Adopter Name:
Address

Street Address

Street Address Line 2

CityState

Postal / Zip CodeCountry
Home Phone Number:

Area CodePhone Number
Work Phone Number:

Area CodePhone Number
Cell Phone Number:

Area CodePhone Number
E-mail
Select Age Group for Adopter:
Number of Adults in Family:
Number of Children in Family:
Ages of Children in Family:
Home:
Do you reside in:
Landlord's Name (if you own your residence then enter "N/A"):
Landlord's Phone # (if you own your residence then enter N/A"):
If you have a landlord you will need to have a letter stating that your landlord approves of you getting a dog and have your landlord sign and date the paper. This can be brought with you when you come to visit the dog.
Do you work:
Who will take care of dog while you are on vacation?
# of Dogs you have:
Breed of 1st Dog (if you do not own a dog, please enter "N/A):
Weight of 1st Dog in lbs.:
Age of 1st Dog in Years:
What is the personality of 1st Dog (Type N/A" if you do not own a dog):
What is name of your vet, phone number, etc. that your dogs go to?
Sex of 1st Dog:
Breed of 2nd Dog (Type in "N/A" if you do not have a second dog:
Is 1st Dog Spayed/Neutered?
Weight of 2nd Dog in lbs.:
Age of 2nd Dog (in Years):
What it ths personality of 2nd Dog (Type in "N/A" if you do not own a second dog):
Sex of 2nd Dog:
Is 2nd Dog Spayed/Neutered?
Breed of 3rd Dog (if you do not have a third dog, please enter "N/A"):
Age of 3rd Dog (in Years):
Weight of 3rd Dog in lbs.(If you do not have a 3rd dog, please select "Not Applicable"):
What is the personality of 3rd Dog (if you do not have a 3rd dog, please type in "N/A"):
Sex of 3rd Dog (select "N/A" if you do not have a 3rd dog):
Is 3rd Dog Spayed/Neutered (Select "Not Applicable "N/A")?
List each Cat's: Age, Weight, Sex, Spayer/Neutered (if you do not have a cat, please type "N/A"):
List other animals you own (Type "N/A" if you do not have any other animals):
If you don't have animals at this time, have you ever had any and if so, what kinds were they and why do you not have them at this time? (If you have not had any other animals, please type in "N/A")
Have you ever turned an animal over to a rescue/shelter and if so, why?
Are your present animals up-to-date on vaccines? (If you do not have any animals, select "N/A")
If not up-to-date on vaccines, why? (If you do not have any animals, please type "N/A")
Do you have a fenced yard?
If the answer is “Partially Fenced or No Fence” then , please explain how you will protect the animal from getting into the highway when you have it outside?
Where will the animal be kept?
Please describe what you are looking for in your pet. List the sex, breed (mix), age, color, weight, height, personality, etc.:
Vet's Name and or Clinic that will be taking care of this animal:
Vet's Phone Number:

Area CodePhone Number
What is the purpose of Animal to you?
Why should you be allowed to adopt this animal? Why do you feel that you can be a responsible and loving home for the animal?
Any other information that you feel is important, please add in the space:
1st Reference

First NameLast Name
Relationship to you:
1st Reference Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail of 1st Reference:
Home Phone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Work Phone Number

Area CodePhone Number
2nd Reference

First NameLast Name
Relationship to You:
2nd Reference Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail of 2nd Reference:
Home Phone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Work Phone Number

Area CodePhone Number
3rd Reference

First NameLast Name
Relationship to You:
3rd Reference Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail of 3rd Reference:
Home Phone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Work Phone Number

Area CodePhone Number
Please understand that if you are not serious about adopting this pet do not waste our time. These dogs are very special and deserve a wonderful, loving and responsible home. Please make sure that you have completed all the information above. If you schedule a time to come and see the dog and cannot make it or change your mind, please cancel your appointment. If for any reason you feel you could not take care of the dog please do not press the submit button below.
I have answered the questions above to the best of my knowledge and have read the information below. I understand that by answering the questions truthfully that it will help H A R T Foundation to select the best possible dog for me to adopt.
Date Submitted:

MonthDayYearHourMinutesAM/PM Option
Type the word below in the space provided below and then click the "Submit Form" button.
Should be Empty:

Application for Amy's Dogs

If you have a landlord you will need to have a letter stating that your landlord approves of you getting a dog and have your landlord sign and date the paper. This can be brought with you when you come to visit the dog.