Name
*
First Name
Last Name
Email
*
Phone
*
(###)
###
####
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Select your age group:
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18-21
22-28
29-38
39-59
60-64
65-70
70+
Employment Status:
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Working (full-time)
Working (part-time)
Student
Retired
Other
Are you a Canadian citizen or permanent resident?
Yes
No
Other
If 'other', please explain:
Have you met this particular dog?
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Why do you want to adopt a dog?
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Why would you make a good adopter?
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Why do you think you would be a good match for this particular dog?
*
Have you previously applied for a dog with Heart and Soul? (If yes, which dog?)
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Please indicate the number of adults (including yourself) in your home:
*
Please indicate the number of children in your home and their ages:
*
Does anyone in your household have allergies to animals?
*
Yes
No
Unsure
Please indicate the number of other pets in your home, and list the following information for each animal below: Type of pet? Spayed or neutered? Vaccinations current?
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Have you ever had a dog before? If yes, what breed? Tell us a bit about your experienced with the dog(s) you have owned:
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Did your other dog(s) die or did you rehome them? Please indicate the circumstance:
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Are there any behaviours a dog might do or not do, that would bother you?
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What behaviours do you have experience with?
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What behaviours are you willing to work on?
*
What brand of food do you feed your dog/puppy or plan to use?
*
How much do you expect to spend per month on dog food, supplies, and other expenses?
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$10 - $25
$35 - $80
$85 - 120
$130+
Do you have access to a vehicle?
*
Yes
No
Where will the dog spend the day?
*
Where will the dog sleep?
*
Do you have a fully fenced yard?
*
Yes
No
Who will care for your dog/puppy on a daily basis?
*
Me
Other
How many hours per day, on average, are you away from home?
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0-4
4-8
8-10
10+
How much time can you dedicate to the dog per day?
*
If you go away, where will the dog stay? Who will take care of them?
*
How would you describe your household?
*
Please indicate your type of residence (House, Condo, Apartment, Townhouse, etc.):
*
Do you own or rent?
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Own
Rent
If you rent, please provide name and phone number of landlord:
*
Are you intending to move within the next year?
*
If something were to happen and you can no longer take care of the dog/puppy, and you had to give the dog/puppy away, which would you choose?
*
Dogs are a lifelong commitment. Do you agree to try and have the dog for the length of its life, and if not contact Heart and Soul Dog and Cat Rescue Society?
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Yes
No
Who is your veterinarian?
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If an unexpected medical condition or emergency came up, would you be able and willing to provide the necessary medical care needed?
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Yes
No
What amount would you be able to spend if a medical emergency were to come up?
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How often do dogs need to go to the veterinarian?
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Once a year
Every 5 years
Only when a problem arises
How long do dogs live?
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5 years
8 years
10-15+ years
If you are unable to keep the adopted dog, do you agree to return the dog to Heart and Soul?
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Yes
No
When would you be ready and able to welcome a dog into your home?
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Any additional information you would like to provide?
Would you be willing to allow one of the volunteers from Heart and Soul Dog and Cat Rescue Society to do a scheduled home visit prior to and/or after the adoption process? If no, please explain:
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You agree that all the information on this application is true and complete and that you fully understand all of the questions. You further understand that any falsified information will terminate the adoption process. You authorize the release of any records relating to the above information. Heart and Soul Dog and Cat Rescue Society reserves the right to refuse any application they deem unsatisfactory. The completion of this form does not guarantee that you will be able to adopt a dog/puppy. You understand that should you be approved to adopt a dog from Heart and Soul Dog and Cat Rescue Society, the dog must sleep indoors and be on leash at all times in public.
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Name
*
First Name
Last Name
Date
*
MM
DD
YYYY
Would you like to be considered to foster for Heart and Soul Dog and Cat Rescue Society?
*
Yes
No
TO COMPLETE YOUR APPLICATION, PLEASE SEND PHOTOS OF YOUR HOME TO: heartandsouldogandcatrescue@gmail.com
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