Name
(need First and Last):
Address
(Required):
(READ:
If you do not live in Michigan, Ohio, Indiana, Kentucky,or live within
25 miles of the state border of one of these states, please do not
continue with this application. We apologize that we're unable to
transport/adopt out to regions outside of the aforementioned areas.)
City,
State, Zip (Required):
Home
Phone (incl. area code):
Cell
Phone (incl area code):
Employer:
Occupation:
Work
Phone:
May
we contact you at work?
Your
email address below is REQUIRED for your Application to be forwarded
correctly to our Placement Team!! If you do not include your
email address, your application will NOT be delivered to us.
Email
Address:
I
am interested in adopting (list dog's name):
Note
that ONLY applies to Puppies: IF this dog is a puppy
and not spayed or neutered, be aware that this puppy is listed under
our "Foster to Adopt "
Program. Click here
for a detailed pop-up window of this program (this will NOT affect
your application progress).
Why
are you choosing to adopt this breed of dog?
Have
you ever owned this breed of dog before?
Are
you familiar with the traits (personality, medical problems, etc?) of
the breed(s) you are interested in?
No
Yes
Somewhat
What
traits do you desire in your pet?
What
types of activities would you like to enjoy with your pet?
For
whom are you adopting?
Myself
Myself and
My Spouse/Significant Other
Myself and my Family
Other
Why
are you adopting a pet?
How
long have you been looking for a pet?
Less than 1 month
3 months or less
6 months or less
6 months to a year
1+ year(s)
Have
you done research to help you know what breed type best suits your needs?
If so, what type of research? What breeds suit you and why?
If
wishing to adopt a larger dog from our rescue (Doberman, Boxer, etc).,
does your Homeowners Insurance allow this type of dog in your neighborhood/city?
What
is your living situation?
If
renting, we must verify with your landlord that you may have this pet
before we can allow it to go home with you. Please list Landlord's
Name and Phone Number:
How
long have you been at your current residence?
Less than 2 years
2 years to 5 years
5 years to 10 years
10 years to 15 years
15+ years
Do
you expect to be moving within the next year?
If
yes, to what type of residence?
Do
you expect any other type of major lifestyle changes in the next two
years?
If
"Other", please explain:
Your
Age:
Age,
Gender and Relation of others living in your home:
Are
all of the above mentioned people agreeable to adding a pet to the household?
If
no, please explain:
Are
any of them allergic to this type of pet?
Who
will be primarily responsible for the pet?
In
what type of area do you live?
Where
will your pet spend the day hours (be specific)?
How
many hours a day will your pet be alone on week days?
None
1-3 hours
3-6 hours
6-9 hours
9+ hours
How
many hours a day will your pet be alone on the weekends?
None
1-3 hours
3-6 hours
6-9 hours
9+ hours
Do
you have a fenced yard?
If
yes, what type of fence?
If
"Other", please explain:
If
no, how will you ensure your pets safety while outdoors and how will
you see that it gets plenty of exercise?
Are
you familiar with crate training?
Are
you familiar with house training?
Will
you be enrolling your dog/puppy in obedience classes?
If
no, why not?
Where
will your pet spend the night (be specific)?
Describe
your work schedule:
Do
you currently have other pets?
If
yes, what kind of other pets?
Please
list names, breed, age, and gender of all current pets.
Where
did you get/acquire each of your pets (list for each current pet)?
Are
your current pets indoor pets, or outdoor pets (list for each current
pet)?
Do
you currently have a Veterinarian?
Veterinarian:
Vet
Full Address (inc. street address, city, state & zip):
Vet
Phone Number (incl. area code):
When
we call to verify information, whose name is on the Vet Records for
your current pet(s)? (Last, First)
Could
you please notify your vet that a representative of True Heart Rescue
will be contacting them?
In
lieu of us calling your vet, if you currently have electronic vet paperwork
available for your current pet(s), and dated within the last year, feel
free to upload it here to speed up your application processing time.
Faxing this information to (678) 866-9147 is another option (Attn: Tiffiny).
(Note that we still may call to verify any information).
If
you had a pet previously, why do you no longer have it?
Are
all of your current pets spayed or neutered?
If
no, why? (Required if you answered "No" above.)
Are
all of your current pets up to date on vaccines (Rabies, 5 in 1 Distemper)?
If
no, why? (Required if you answered "No" above.)
Are
all of your current pets on heartworm preventative and flea control
medications?
If
no, why? (Required if you answered "No" above.)
Are
you aware that the average pet costs in excess of $700.00 per year in
just food and vaccinations, and that the average life span is 15 years?
Are
you committed to providing this pet with necessary medical care and
obedience training to ensure its well being in your home for its lifetime?
For
what reason(s) would you give up your pet(s)?
What
would you do with your pet if you did ever have to give it up?
We
will need you to list two references' names (other than relatives
or significant other), relation and phone number (incl. area code)
below. Email addresses are optional, however, applications with
email addresses have a quicker turn around time due to the convenience
of email of both the rescue, and your references'.
List
Reference 1 here (Name):
Reference
1 Phone Number (Must include area code):
Reference
1 Email address (used strictly to process your application in a timely
manner):
Relation;
How do you know this person?
Please
list Reference 2 here (Name):
Reference
2 Phone Number (Must include area code):
Reference
2 Email address (used strictly to process your application in a timely
manner):
Relation;
How do you know this person?
Please
write some thoughts telling us what makes you the best possible owner
for this pet:
Would
you agree to a representative of True Heart Minpin Rescue verifying
this information and following up on the placement of this animal?
If
you are interested in a puppy, note that we do not adopt out unaltered
puppies. Would you be willing to participate in our "Foster to
Adopt" program (fostering the dog until it is altered, then completing
the adoption papers) if wanting to adopt one of our unaltered puppies?
If
you selected "Yes" above, have you read and understand our
Foster to Adopt program
details?
And
again, if you selected "Yes" above, have you met the requirement
of living within 100 miles
of a Rescue Coordinator ?
Disclaimer:
True Heart Minpin Rescue, Inc. is a volunteer nonprofit organization,
registered in the state of Kentucky. Our animals are not for sale, they
are for adoption. This means a home must be approved before adoption.
Approval includes, but not limited to, completing this pre-application
form, additional interviews, meeting with the prospective pet, and a
signed contract. In addition, True Heart Minpin Rescue, Inc. reserves
the right to deny an adoption at any time during the process for any
reason.
Enter
your name below acknowledging the above Disclaimer, and to electronically
sign this application prior to submittal.
Where
did you hear about us? (If you heard about us from one of our
PetSmart Adoption Events
PetFinder
PetSmart Adoption Event
Internet Search Engine
1-800-Save-A-Pet
Pets 9-1-1
Friend
Relative
Colleague
Other
If
other, we'd love to know where you heard about us:
We
really appreciate your patience; our adoption process may take 2-3
weeks to complete.
PLEASE
MAKE CERTAIN YOU HAVE FILLED OUT ALL FIELDS PRIOR TO SUBMITTING!!
IF
APPROVED, KEEP IN MIND DONATION ADOPTION FEES MUST BE PAID VIA CREDIT
CARD (ON OUR SITE) OR BY MONEY ORDER ONLY. SORRY, WE DO NOT TAKE PERSONAL
CHECKS.
**SUBMIT
YOUR APPLICATION BELOW**
