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.