Hearts United for Animals Preadoption Application

 Name:                       Phone:  (H)                 (W)
 Address:                    Fax:  
 City: 						 State:       Zip:                                               
 Email:						 Driver's License:

1. Why do you want to adopt a dog?

2. What do you think are the most important responsibilities of being a guardian to a dog?

3. For whom are you adopting the dog?

4. Have you ever been a guardian to a pet before?

a. Please describe those pets who are currently with you (type, age, sex, altered status).

b. Please describe those pets that are no longer with you (type, age, sex, altered status).

c. What happened to the pets who are no longer with you?

5. Please provide the name and phone number of the veterinarian for your pets.

6. How many people reside in your household?

7. Are there any children in the household? a. If yes, what are their ages?

8. Does anyone have allergies?

9. Who will be responsible for feeding, housebreaking and training?

10. Do you own or rent your residence?

a. If you rent, please provide the name and phone number of your landlord.

11. What type of home do you live in (1 family, 2 family, Condo, Apt., Farm)?

12. Does your residence have a yard?

a. If yes, please state the size.

13. Is your yard fenced?

a. If so, what type of fence?

b. What portion of the yard is fenced and how high is the fence?

14. Where will the dog stay during the day (inside, outside, both)?

15. Where will the dog stay during the night (inside, outside, both)?

16. How much time will the dog spend outside?

17. Will anyone be home during the day?

18. How many hours will the dog be left unattended?

19. When no one is home, where will the dog be kept?

20. Where will the dog sleep?

21. What do you intend to feed the dog?

22. How will you housebreak the dog?

23. Please provide the company name, address and phone number for the place of employment

for each adult in the household.

24. How frequently will the adults be gone away from home on business/ vacation/ trips?

25. Please list any preference you have in adopting a dog (age, sex, breed, personality).

References:

Name:

Address:

Phone:

I represent that the information that I have provided on this form is the truth to the best of my knowledge

and belief.

Signed: ___________________________________ Date: _______________________

Fax to 402-274-3689 or Mail to HUA Box 286 Auburn, NE 68305 or copy and paste into e-mail and send to jenny@hua.org. E-mail receives the fastest response.

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