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HART of Cincinnati, Inc. Dog Adoption Application

Submission Preview

…

**`* Indicates Required Fields`**

ABOUT YOU

Name*

Address*

Phone*

Email*

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 in (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 on monthly 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 have a fenced yard?

yes

No

If Yes What type of fence is it

Physical

Invisable

If it is a physical fence , what height is it?

If You Rent please answer the following.

What is your landlords name?:

What is your landlords phone number?:

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

Are there any breed restrictions?

Is there a weight limit for animals living in your apartment?:

Yes

No

End Rent Section Requirements

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:*

Reference #1 phone number:*

Reference #2 name:*

Reference #2 Street address:*

Reference #2 phone number:*

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.

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