Name
(Need first & last) :
Address
(Needed ):
City,
State, Zip (Needed ):
Home
Phone (Needed : incl. area code):
Cell
Phone (incl area code):
Employer:
Occupation:
Work
Phone:
May
we contact you at work?
No
Yes
Email
Address: (REQUIRED for your Application to be forwarded
correctly to our Placement Team!!)
I
am interested in adopting (list dog's name) - If
unaltered (non-spayed/neutered) dog/puppy, click
here for a pop-up window:
What
traits do you desire in your pet?
Are
you familiar with the traits (personality, medical problems, etc?) of
the breed(s) you are interested in?
No
Yes
Somewhat
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, etc), does
your Homeowners Insurance allow this type of dog in your neighborhood/city?
No
Yes
N/A - Not adopting a larger dog
What
is your living situation?
Own Home
Rent Home/Condo
Rent Apartment
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?
Yes
No
If
yes, to what type of residence?
Do
you expect any other type of major lifestyle changes in the next two
years?
Marriage
New Baby
Caring for Elderly Relative
Other
None
If
"Other", please explain:
Your
Age:
18-22 years
22-25 years
25-30 years
30-40 years
40-50 years
50+ years
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?
Yes
No
If
no, please explain:
Are
any of them allergic to this type of pet?
Yes
No
Who
will be primarily responsible for the pet?
In
what type of area do you live?
City
Suburb
Rural
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?
Yes
No
If
yes, what type of fence?
No Fence
Chain Link
Privacy
Invisible
Other
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?
Yes
No
Are
you familiar with house training?
Yes
No
Will
you be enrolling your dog/puppy in obedience classes?
Yes
No
If
no, why not?
Where
will your pet spend the night (be specific)?
Describe
your work schedule:
Do
you currently have other pets?
Yes
No
If
yes, what kind of other pets?
None
1 Dog
2 Dogs
3 or more Dogs
1 Cat
2 Cats
3 or more Cats
Other
Please
give names, breed, age, gender, personality and where acquired. Indoor
or outdoor?
Do
you currently have a Veterinarian?
Yes
No (skip to next set of required questions)
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?
No Current Vet
Yes
No
If
you had a pet previously, why do you no longer have it?
Are
all of your current pets spayed or neutered?
No
Yes
No Current Pets
If
no, why?
Are
all of your current pets up to date on vaccines (Rabies, 5 in 1 Distemper)?
No
Yes
No Current Pets
If
no, why?
Are
all of your current pets on heartworm preventative and flea control
medications?
No
Yes
No Current Pets
If
no, why?
Is
your current pet(s) inside pets?
No - Outdoor Pet(s)
Yes - Indoor Pet(s)
Have Both Indoor
& Outdoor Pets
No Current Pets
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?
Yes
No
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?
Yes
No
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?
Please
list two references' names (other than relatives or significant
other), relation and phone number (incl. area code). List Reference
1 here:
Reference
1 Email address (used strictly to process your application in a timely
manner):
Please
list Reference 2 here(other than relatives or significant other), relation,
and phone number (incl. area code):
Reference
2 Email address (used strictly to process your application in a timely
manner):
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, completing a home visit in your home,
and following up on the placement of this animal (all required
to adopt a dog from us)?
Yes - Please Verify
No - Do Not Verify
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? (Clicking the link in this question will open in
a new window and will NOT interfere with your survey answers.)
N/A - Not adopting a puppy
No
Yes (required to adopt an unaltered puppy)
Maybe
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.
I have read and understand the above disclaimer.
I do not agree with the above disclaimer.
Enter
your name below acknowledging the above Disclaimer, and to sign this
application prior to submittal.
Where
did you hear about us?
PetFinder
1-800-Save-A-Pet
Pets 9-1-1
Other Pet Site
Search Engine
Friend
Relative
Colleague
Link in Email
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 understand that we are volunteers that hold full-time outside
jobs and have our own families,
but be assured that your application is important to us, and we will
process it as quickly as possible.)
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 MONEY
ORDER ONLY.