Adoption Application - Mended Hearts Rescue

Name of animal you are interested in: *

You may list more than one.

Name *

First

Last *

Last

Your Age *

Email *

Phone *

Best time to call you *

Morning

Afternoon

Evening

OtherOther

Mailing Address *

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal

Physical Address (if different from mailing)

Address 1

Address 2

City

State/Province

Zip/Postal

Household Residents *

Please list the name and age of all people living in your home, including yourself, and indicate if they live in the home full or part time.

Are all residents in agreement to adopt a pet?

Yes

No

I don’t know

Are any residents allergic to the type of pet you are applying to adopt?

Yes

No

I don’t know

Do you own or rent your home? *

Own

Rent – please provide landlord info below

OtherOther

Housing Type *

Landlord Information *

For renters, please provide the name and phone number for your landlord. We will confirm you are authorized to have the species and breed of pet you are interested in. If you own your home put N/A.

Please tell us about your yard *

Note: We don’t have any general fence requirements, but certain animals may have specific needs.

Current Pets *

Please list any other animals you have living in your home (part or full time) with their name, age, type of animal/breed. and how long you have had them. Please type N/A if none.

Are all your current pets fixed (spayed/neutered)? *

Yes

No

No current pets

Are your pets current on vaccines as well as flea and heartworm prevention? *

Yes

No

No current pets

Name of current veterinarian (if applicable) *

Please list contact phone number for your veterinarian with name.

Where will this pet be kept when left alone? *

How many hours will this pet be left alone a day? *

Where will this pet sleep at night? *

What about this particular animal interests you? i.e. what are you looking for in a pet? *

Previous Pets in Last 5 Years *

Please list the previous pets you’ve had in the last five years, pet type/breed, and why they are no longer with you.

Is there anything else you would like to tell us? *

Providing additional information to help us get to know you is highly encouraged!

How did you hear about this animal? *

By typing my name below, I certify that all the answers to this adoption application are true to the best of my knowledge. I understand that this is an inquiry for adoption and does not constitute an adoption contract. I authorize Mended Hearts Rescue to contact my landlord or current veterinarian (if applicable) and for these parties to release information to Mended Hearts Rescue regarding my inquiry. I understand my application may not be processed if all applicable and required information is not provided. *

Disclaimer

Thank you for your interest in adopting! We are an all volunteer operated organization and initial application processing times can take up to two weeks. We appreciate your patience! Please continue to check your email for further communication.

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