HART of Cincinnati, Inc. Dog Adoption Application
*** If you are using a browser other than Internet Explorer you may not be able to submit this form *** *** If this is the case - please use this excel document.  Attach and mail it back to:  doghart@gmail.com ***
About You
(fields with gray boxes are required)
Your Name:
Street Address:
City, State, Zip:
Phone Number (day):	eg:(513)123-4567
Phone Number (evening or cell):	eg:(513)123-4567
Email Address:
Do you want to be on our e-mail distribution?:	Yes No
About The Dog
Why do you want to adopt?:
Name of Particular Dog you are interested (if any):
Are you currently the foster family for this dog?:	Yes          No
Type of dog you are looking for:
Age Range:
Size:
Gender:
Activity Level:
Where will the dog be when no one is home?:
Where will the dog be when someone is home?:
How many hours will the dog be home alone?:
Do you have a fenced yard?:	Yes          No
Where will the dog sleep?:
Do you plan on obedience training?:	Yes          No
Have you ever relinquished a pet to a shelter or someone else? (if yes, why?):
About Vet
Do you have a vet?:	Yes          No
Vet Information:
Vet's Name:
Vet's Phone Number:
About Your Household
Number of adults in the household?:
Number of children in the household?:
Ages of Children?:
Do children visit you?:	Yes          No
Does anyone in you household have an allergy to dogs?:	Yes          No
About Current Pets
What pets do you currently have?:
Names of Current Pets:
Ages of Current Pets:
Are your pets up to date on vaccinations?:	Yes          No          N/A
Approximate date of last vaccination:
Are your pets up to date on Heart Worm prevention?:	Yes          No
Other pets you've had in the last 5 years?:
What happened to other pets?:
Additional Information Required
Do you rent or own?:	Rent          Own
If you rent: What is your landlords name?: What is your landlords phone number?: eg:(513)123-4567 Have you contacted your landlord to make sure pet's are allowed?: Yes          No Is there an increase on your rent for housing an animal in your apartment?: Yes          No Is there a weight limit for animals living in your apartment?: Yes          No
What will happen to your dog if you move?:
Do you know where to get a dog license for where you live?:	Yes          No
Would you agree to a home visit?:	Yes          No
How did you hear about HART?:
We require 2 references: Reference #1 name: Reference #1 Street address:      City: State: Zip: Reference #1 phone number: eg:(513)123-4567 Reference #2 name: Reference #2 Street address:      City: State: Zip: Reference #2 phone number: eg:(513)123-4567