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Are You Interested in Adopting a Pet or Volunteering:
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Your First and Last Names:
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Year You Were Born:
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Your Full Home Street Address:
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Your Email Address. PLEASE make sure to turn your spam blocker off, so we can send
email to you:
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What Kind of Pet Are You Looking For:
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Dog
Cat
Female
Male
Either Sex
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What Age Range Are You Looking For:
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Adult (over 1 year)
Adolescent
Baby
No Preference
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Do you want a purebred and if so, what breed:
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Do you want a particular size, color, or markings:
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How Did You Hear About In Your Heart:
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website
vet
family
friend
neighbor
petstore
other
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Name of Referrer:
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Reason for Pet:
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Does Your Whole Immediate Family Want the Pet:
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No
Yes
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Your Questions for Rescuers:
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Do You Agree to a Home Inspection:
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Yes
No
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Own or Rent Your Home:
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Own
Rent
Live with relatives
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What Type of Home Do You Live In:
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House
Apt
T_House
Condo
M_H
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If Renting, Please List Pet Deposit Required and Breed or Weight Restrictions.
Verification Will Be Required That You Are Authorized a Pet by Your Landlord.
Please email a copy of your lease to:
jodunham100@earthlink.net
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If Renting Apt., Name of Complex and City:
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Landlord Name and Phone Number:
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Your Home Phone Number:
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Your Work Shift and Phone Number:
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Best Time & Place to be Called:
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Miles You are Willing to Travel for Pet:
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50
Any
Will Fly
Air Freight
Can’t
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All of our available pets may have a "past." To aid us in placing the right pet in your home, please select the most appropriate statement:
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I Want a Pet That:
Fits My Lifestyle
May Require Lifestyle Change
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Is Your Family Planning On Having a Baby:
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No
Yes
Maybe
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Your Living Arrangements:
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Married
Roommates
Alone
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Number of Adults in Your Home:
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One
Two
Three
More
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Please List Number, Ages, and Sex of Children:
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Do the Children Live there with You:
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Please List Ages of Any Grandchildren Who Visit:
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Is Anyone Close to You Having a Baby? Who:
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Who Has Allergies and to What Animals:
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Have All Residents Lived With Dogs:
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Will the Pet Be a Gift, and If So, For Whom:
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Who Will Care for it:
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What if it Bites Someone:
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How Would You House Train it:
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Where Would It Stay:
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Loose in House
Garage
Mud Room
Outdoors
Kennel Run
Tie-Out
Crate Indoors
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Will the Pet be Crate/Cage-Trained:
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No
Yes
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Will You Attend Obedience Classes:
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No
Yes
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| Are You Prepared for Howling, Chewing, Scratching Furniture,
Running Away, and Other Mischievous Behavior? How Would You Reprimand the Pet:
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How Many Hours Would it be Alone?
How Many Hours Crated?
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If You Have a Yard, is it Fenced? If So, What Type and Height? If Not Fenced, How Would You
Keep Your Pet in Your Yard:
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Where and How Would You Exercise Your Pet:
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Describe Your Current Pets Name, Breed, Wgt., Indoor/Outdoor, Neutered, Age, Sex, Date Last Vaccinated,
Cat Declawed? 2-or-4-paw:
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Describe Other Pets You Have Had in the Last 5 Years and What Happened to Them. Euthanized? Died of Natural Causes? Run Over? Gave Them Away (Why and to Whom?) Sell Them?
Take Them to the Pound?
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What Will You Do With It If You Have to Move:
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Have You Applied For a Pet at Other Shelters? Where? When? If Ours, Which Pet:
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Your Vet, Clinic Name, City, and Phone No.:
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Your Character Reference 1 Name and Phone No.:
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Your Character Reference 2 Name and Phone No.:
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Your Employer’s Name and Phone No.:
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I certify that the information provided is complete and correct to the best of my knowledge. I understand that if it is found that I have misrepresented myself or any information on this questionnaire, it may prevent "In Your Heart" from adopting an animal to my family or me or render the adoption null and void which will require return of the adopted pet to "In Your Heart."
You may contact my veterinarian for medical information and my rental/leasing agent, if applicable, for verification.
Clicking SUBMIT signifies I agree to this. I also agree to sign a print-out of this form in writing before receiving a pet. -->
(SUBMIT will email your application to us, then return you to our homepage.)
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