Hospice Hearts · Adoption Application

The Adoption Coordinator will contact you within 72 hours. The adoption process may take two to seven days and includes a review of your application, vet reference and home visit. We strongly recommend that all household members be present during the meet and greet visit and final adoption to ensure the pet is a good fit with the entire home. Residency requirements will be verified. Be truthful in your responses so that the Adoption Coordinator can help find the best pet for your household and/or family. Failure to provide truthful answers will result in nullification of your application and contract. The application questions are not optional – all questions must be answered.

The Adoption Coordinator’s primary responsibility is placing the pet in a home that best meets the particular needs of the pet. Applicants are encouraged to review all available animals and ask questions of the Adoption Coordinator to determine which pet would be best suited for your home. Please note that Hospice Hearts is an all-volunteer organization and we appreciate your respectful treatment.

*Notice*

Our pets and adoption are “Satisfaction Guaranteed.” We understand that not all animals fit all families and living situations. Our adopted animals can always be returned to Hospice Hearts during the two-week trial period. If an animal is returned, we do not deny future adoption, and can help find a better match for you and your family. We also will help with any questions or concerns you have with your adopted animal at any time to help keep them in your home if possible.

Name of Animal

*

*Adoption Fee*

The fee for adopting a Hospice Hearts cat is a minimum $50.00 donation. The fee for adopting a dog is a minimum $100.00 donation.

Name

*

First Name

Last Name

Your Date of Birth

*

(mm/dd/yyyy)

Marital Status

Phone Number

*

Email

*

Verify Email

*

Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Adoption Interests

What makes you want to adopt this animal into your home at this time?

*

Do you have any concerns with this particular animal, or issues you are concerned about with any animal? Our adoption coordinator will share information with you to help ease any concerns or create better transitions for you and your adopted companion.

*

What qualities are you looking for in a new companion? This can help us make a better match, or help us find an animal that meets your needs once they enter our program.

*

Background Information

How many adults are in the household?

*

How many children are in the household?

*

If no children, please put "None" in the box.

What are their ages?

*

Do you own or rent?

*

Own

Rent

Name of Landlord

*

Telephone Number of Landlord

*

Are pets allowed in your lease?

*

Yes

No

Are there any breed or weight restrictions?

*

Yes

No

Do you live in a smoke-free home?

*

Yes

No

Are you and/or your spouse/significant other currently employed?

*

Yes, both.

Yes, one.

No, neither.

Retired, both.

Retired, one.

Who is your employer?

*

Employer Telephone Number

*

Other adult(s) in household employers?

If applicable

Employer Telephone Numbers

Matching the Right Pet

I am interested in adopting the following...

*

Dog

Cat

I am interested in the following ages...

*

Young (<1 year)

Adult (1-8 years)

Senior (8+ years)

I am interested in the following sized dog...

*

Small (<20 pounds)

Medium (20-50 pounds)

Large (50+ pounds)

Are you looking for a declawed cat?

*

Yes

No

Where will this animal primarily be kept?

*

Inside

Outside

Garage

Barn

I want a pet with the following activity level(s):

*

Couch Potato

Moderately Active

Exercise Buddy (very active)

Are you willing to care for an animal requiring a specialized diet (ex. for diabetes, weight loss, etc.)?

*

Yes

No

If your adopted cat or dog became very ill, would you be willing to spend money on extensive vet care? What would you do to ensure a good quality of life?

*

Pet History

Do you currently have pets at home?

*

Yes

No

How many?

*

Please indicate the breed, age, sex, if they are spayed or neutered, and/or declawed (cat).

*

Please include all information.

What food do you feed your current pets?

*

Current Veterinarian (include phone number)

*

Name, location (city/state)

Have you owned other pets in the past 5 years?

*

Were any of them

*

Lost

Hit by a vehicle

Put to sleep

Relinquished

Other

N/A

I, the undersigned, certify that the information provided in this application is complete and accurate to the best of my knowledge. I understand that any and all information provided may be subject to verification. I, along with those persons accompanying me, assume risk of injury which may be incurred as a result of viewing any animal under the care of Hospice Hearts.

Signature

*

Date

*

(mm/dd/yyyy)