Dog Adoption Application

DOG ADOPTION APPLICATION - HEARTLAND ANIMAL SHELTER

Heartland Animal Shelter reserves the right to approve or deny applications. Applications are considered with the best interests of the animals in mind and should not be construed as a reflection on the applicant. In order to adopt, applicants must:

1) Be 21 years of age or older and a U.S. citizen,

2) Have the consent of all adults living in the household,

3) Have a valid state-issued ID with current address, and

4) Have a current lease or landlord's name and phone number for verification that pets are allowed (for renters only).

Please Note: False or omitted information will result in an application being denied.

Date

What is the name of the Heartland dog(s) you are interested in adopting?

If you do not yet have a particular dog that you are interested in, what type of dog are you interested in

adopting?

Your Name

Your Email Address

Work #

Cell #

Home#

Home Address

City

State

Zip

Employer

Employer's Phone

Veterinarian’s Name

Veterinarian's Phone

Personal Reference #1 (cannot be a relative)

Personal Reference #1 Phone

Personal Reference #2 (cannot be a relative)

Personal Reference #2 Phone

Tell Us About Your Household:

Please select your type of residence:

Do you RENT or OWN your residence: (select one)

Landlord's Name (renters only)

Landlord's Phone # (renters only)

Number of Adults in Household

Number of Children in Household

Children's' Ages

Who will be responsible for feeding the pet?

Who will be responsible for training the pet?

Why are you seeking to adopt a dog today? (Please check all that apply)

Companion for Adults

Companion for Another Pet

A Gift

Guard Dog or Watch Dog

Other Reason for Seeking a Pet?

What current pets or other pets have you had in the last five years?

Pet's Name Type/Breed Kept Where? Age Gender Spayed Status

When was your pets' last visit to the vet?

What was the purpose of the vet visit?

Is anyone in your household allergic to dogs?

If you move, what will you do with your pet(s)?

Under what circumstances would you not keep the dog?

If an unlanned or unforeseen circumstance happened (death or severe injury) and you could no longer care for your pet, is there a backup person you will make arrangements with? If yes, please list name, relationship and phone number. If no, what will happen to your pet?

What days/times would be convenient for a follow-up home visit by Heartland?

Approximately how much do you anticipate spending annually to feed, vaccinate, license, and provide medical care (routine and emergency) for your new dog?

The pet will be without human companionship for approximately hours per day

Where will the dog be kept during the day?

During the evening?

If adopting a puppy, how do you plan to housebreak?

How do you plan on addressing behavioral problems such as:

Barking?

Chewing or other destructive behavior?

Digging?

Growling, snapping, guarding, or other aggressive behavior?

Do you plan to take your dog to training classes?

If yes, where?

What type of identification do you plan to place on your dog?

Dogs can take up to a month to adjust to their new homes, particularly if there are other pets.

Are you willing to devote this time?

By submitting this application to Heartland Animal Shelter, I recognize that this application is the property of Heartland Animal Shelter. I certify that the information I have given is true and correct. I understand that false information can result in the denial of this adoption. I authorize Heartland Animal Shelter to investigate the statements on the application, and further understand that Heartland has the right to deny this application for any reason.

Please click once and you will receive a thank you page confirming your information was received