Adoption Inquiry If you are interested in learning more about one of our animals, please complete the form below. If you are having trouble with the form, you can download a paper copy and email it to us. MHR Adoption Inquiry Your Name *required Mailing address * City * State * Zip Code * Physical address (if different than mailing) City State Zip Code Primary Phone * Best time to call you * Email * Date of Birth * Please list the name and age of all people living in the home * Do you own or rent your home? * Own Rent Other If Other, please explain RENTERS ONLY: Does your landlord have any pet restrictions? (select all that apply) No restrictions Breed restrictions Weight limit Number limit I don't know Other If Other, please explain RENTERS ONLY: Please provide landlord's contact information Please tell us about your yard * No yard Unfenced yard Partially fenced yard Invisible fence Tie out / trolley Competely fenced - under 4 feet tall Completely fenced - over 4 feet tall Please list any other animals (name, age, breed) you have living in your home (part or full time) * Are the animals in your home fixed? Yes No If no, please explain the circumstances Name of animal you are interested in * How did you hear about this animal / Mended Hearts? * Petfinder Facebook Friend Other rescue/shelter Website Other By typing my name below, I certify that all the answers to this inquiry 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 (if applicable) and for these parties to release information to Mended Hearts Rescue regarding my inquiry. *required Please confirm you're not a robot.