What would you like to adopt?

Dog
Cat

Is this application to be a permanent or a foster pet family?

Permanent
Foster

Pet's Name & ID

Approximate age of pet

Breed if known

Applicant Name:

Applicant's Physical Address where the pet will reside:

Phone :

Email:

Do you rent or own your home? If rent, include name of landlord.

What is your occupation?

How many people live in your home?

List ages of children in your home:

Please enter your facebook name if you have one.

Describe Pet's Living Quarters:

How many hours a day will he/she be left home alone?

Fully fenced in yard?

Yes
No

Describe all other Pets living in your home:

Are all pets in your home spayed or neutered as well as up to date on vaccinations?

How will you exercise the dog?

What monthly heartworm preventative do you use?

What monthly flea/tick preventative do you use?

Veterinary name and phone #.

We do check Veterinary References. Please give us the name of your pet and the name the vet record would be under.

Have you ever rehomed or surrendered a pet to a shelter? If so please explain why.

List reasons that would cause you to rehome a pet.

Will you allow our staff to conduct a home visit prior to adoption?

Yes
No
Not sure

Are you financially prepared to take care of this pet for routine veterinary, food and shelter?

I certify that the information provided on this application is accurate. I understand that withholding of information or giving false information will result in a refusal to adopt or having adopted pet taken back at anytime.

I agree
I do not agree

Terms and Conditions of Adoption: If the pet you are adopting proves to be unsuitable, you will contact us. We will gladly take the pet back at anytime to find it another loving home. The adoption fee is only refundable up to 10 days from the date paid. Upon adoption, a follow-up visit at your home by a member of Animal Rescue may be required. Hart County Animal Rescue reserves the right to refuse any application.

I understand that if selected as an adoptive home, I will comply with the following conditions of adoption:

I will provide adequate veterinary care for the pet I adopt, including annual vaccinations, rabies vaccinations, and other care recommend by my veterinarian.

Yes

I will sign and abide by this adoption contract if approved for adoption.

Yes

I accept the terms and conditions of adoption and verify that all information entered is true and correct:

Yes

How will you be paying adoption fee?

Date of Application:

Are you 18 years or older?

Yes
No

Name of person completing this form:

Thank you for your application. A representative from Hart County Animal Rescue will be in touch with you within 24 hrs.