HART of Cincinnati, Inc. Dog Adoption Application
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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
Please note that HART does not have a shelter or other physical location. All animals in our care are located either in a foster home of one of our volunteers or temporarily in boarding at one of the veterinary hospitals or boarding facilities that we coordiante with. Consequently, there may be some delay between submitting your Application and the time that you receive a response from one of our volunteers and can meet the animal of interest, but we will contact you as soon as we can, typically within 24-48 hours.