HART Of Wisconsin Adoption Application Form

This application must be fully completed for us to be able to process it. You will be asked to provide your Veterinary's information and contact information for 3 personal references. You will also be asked about specific data on any animals you currently have and those that you've had in the past. Before beginning the application, please have this information close. If you do not know which dog you want to adopt, or you are looking at more than 1 dog, indicate this in the box marked "Dog's Name". If you have been talking to a HART Representative, please put his/her name in the box marked "HART Rep" so we may get this application to the right person.

Use your tab key to move from line to line on this application
Name of Dog:
 
HART Representative:
Your Name:
Age:
Spouse:
Age of Spouse:
Email Address:
  No Email?  Check This Box: 
Home Address:
City:
State:   Zip:
Mailing Address: Leave back if it is the same as above:
Street:
City:
State:   Zip:
Home Phone: () - Day  Night
Work Phone: () - Ext. Day Night
Do you own or rent your home?
How long at current address?
If you rent, do you have
permission to get this pet?
Landlord's Name:
City:   State:
Telephone: () -
Your Occupation:
Your Spouse's Occupation:
Others living in your home:
Name: Age: Female Male
Name: Age: Female Male
Name: Age: Female Male
Name: Age: Female Male
Current number of pets:
Pet 1 Pet 2
Name: Name:
Age: Age:
Sex: Sex:
Species: Species:
Breed: Breed:
Spay/Neuter: Spay/Neuter:
Temperament: Temperament:
Vaccinations: Vaccinations:
Pet 3 Pet 4
Name: Name:
Age: Age:
Sex: Sex:
Species: Species:
Breed: Breed:
Spay/Neuter: Spay/Neuter:
Temperament: Temperament:
Vaccinations: Vaccinations:
Pets you've had in the past:  
  Pet 1   Pet 2
Name: Name:
Age at Death: Age at Death:
Sex: Sex:
Species: Species:
Breed: Breed:
Spay/Neuter: Spay/Neuter:
Vaccinations: Vaccinations:
What happened to the pet: What happened to the pet:
  Pet 3   Pet 4
Name: Name:
Age at Death: Age at Death:
Sex: Sex:
Species: Species:
Breed: Breed:
Spay/Neuter: Spay/Neuter:
Vaccinations: Vaccinations:
What happened to the pet: What happened to the pet:
Veterinarian Information:  
Vet's Name:
Clinic Name:
City: State:
Clinic hours:
Telephone: (  )  -  
May we call your vet for a reference?
General Questions:
1.
Why would you like to adopt this dog and why do you feel that you could provide a good home?
2. What would you consider to be unacceptable behavior(s) in your home that would cause you to return or give up the dog?
3. Have you ever returned an animal for any reason? If so, why?
4.
What member of the family will be taking the major responsibility of caring for the dog?
5.  Do you have a fenced in yard? If so, describe the fence (type, construction, height). If you do not have a fence, where and how will the dog be exercised and be allowed to eliminate?
6. Where will the dog live? Where will the dog sleep at night and be kept when there is no one at home?
7. How many hours per day do you expect the dog to be left alone?
8. Do you own a dog crate, food & water bowls, leash, bath items, etc.? Please list:(if not, are you willing to obtain them)
9. If you move, what will you do with the dog?
10. When you go on vacation, where will your dog go and who will care of it?
11. Rescued animals need time to adjust to a new home. Are you willing to give this dog adequate time to adjust to it's new environment, at least one month? How will you help to make the transition easier?
12. What Are you aware of the costs of providing veterinary care, vaccinations, and proper diet for a pet? What would you estimate the annual cost would be?
14.
Are you aware that adopting a dog is a long term commitment that may last in excess of 10 years?
15.
Are all family members in agreement about getting this dog?
Additional Comments:
References: People you've known for at least 2 years
Name:
Address:
City: State:
Best time to call:
Telephone: (  )  -  
Name:
Address:
City: State:
Best time to call:
Telephone: (  )  -  
Name:
Address:

City:

 State:
Best time to call:
Telephone: (  )  -  

I understand that in order to complete processing of this application, a visit to my home may be required. This will be scheduled with a HART of Wisconsin Representative. I acknowledge that all of the information contained in this form is true and correct. I understand that any misrepresentation of facts will result in the removal of an adopted dog from my home by a HART Of Wisconsin Representative

We Reserve The Right To Refuse Any Applicant