In order to be considered for an adoption you must:
Be at least 23 yrs of age.
Have the knowledge and consent of all adults living in your household.
Have a landlord's name and phone number if you rent
Understand that Heartland Humane Society must approve your application
Applicants Name:
Age:
Address:
City:
State:
Zip Code:
Home Phone:
Work Phone:
Driver's License Number:
State:
DO YOU?
Employer:
How Long:
DO YOU LIVE IN A?
DO YOU?
(if Rent, MUST provide landlord information)
Landlord's Name:
Landlord's Phone:
Does everyone in your household know and accept the fact that you are considering adopting a new pet?
Number of adults in your household?
Number of children in your household and their ages?
Which pet are you interested in?
Does anyone in your household have allergies to animals?
Do you have a fenced yard?
How high is the fence?
Doghouse?
Do you plan to move soon?
Which family member will be primarily responsible for?
Feeding:
Training:
What type of food will you feed your new pet?
Are you aware of crate training?
Where will your new pet sleep at night?
E-mail address:
How much time do you plan to spend with this pet daily?
How many hours will your new pet be home alone?
What will happen if your pet grows larger then expected?
What circumstances would lead you to give up your new pet?
If you had to give up your new pet, what would you do with him/her?
If adopting a dog, how will you supervise outdoor activity?
If adopting a cat, will you allow the cat to go outside?
If you do allow the cat to go outside, how will you provide for the safety of the cat?
Please check indicating why you would like to adopt an animal from us. Check all that apply:
What type(s) of pets do you own or have you owned during the past five years?
Do you still own any of them?
If so, where do they spend most of their time?
How are they confined?
When outside, what type of shelter do they have?
Are your current pets altered?
Who is your veterinarian?
Veterinarian's telephone number:
When and where were your current pets last vaccinated? (We check vet references)
What would be convenient times for a representative of Heartland Humane Society to check on this animal's well being?
Do you understand that a pet can be an 18 year commitment, must be regularly
exercised and groomed, and can cost $300-$500 per year to care for?
Do you realize that your new pet may take anywhere from 2 weeks to 2 months to become adusted to its surroundings, and may require extra patience and training during this stressful time?
Have you adopted a pet from Heatland Humane Society before?
If yes, how long ago?
Do you still have this pet?
If not, what happened to it?
Do you realize that, if at any time, things do not work out with your new pet, that it should be returned to Heartland Human Society only?
STRAYS: I understand that no information is available about the prior history, behavior, or temperament of this dog/cat. (please initial)
Additional Comments:
By submitting this form, I certify that the information I have given on this application and in my interview with the shelter representative is true and accurate, and I recognize that any misrepresentation of facts may result in my losing the priviledge of adopting a pet. Neither myself, nor any other person living in my household, has ever been convicted, either in the adult or juvenile court system, of any act of animal cruelty or neglect.
In addition, I understand that Heartland Humane Society has the right to deny my request to adopt an animal for any reason, and I authorize investigation of all statements in the application. I understand that my pet should see a veterinarian within 5 days after adoption. I further understand that this application is the property of Heartland Humane Society.
We would like to remind you that filling out a Pre-Adoption
Application is not an Adoption Agreement.
Heartland Humane Society reserves the right to deny any application for adoption. We want to ensure that all completed adoptions are in the best interest of both the animals and the family.
