AHeinz57 Pet Rescue & Transport

Adoption Application

*What is the name of the pet you are applying for? Where did you first learn about this pet?
Website  Petfinder.com  Newspaper  Flyers  Friend/Family/Co-Worker  Petango.com
Petco Adoption Day
*Full Name: *Street Address: *City: *State *Zipcode: *Telephone Number *Email: *Employer: *Names & Ages of all household members:
*Do you own or rent your home?
Own  Rent  *If renting, do you have your landlord's permission to adopt a pet?
Yes  No  N/A  Landlord's Name: Landlord's Phone Number: If you own a Townhouse or Condo, do you have a back yard? *Do you have plans to move in the future?
Yes  No  If yes, what do you plan to do with your pet?
*Do you have other pets at home?
Yes  No  If yes, please tell us the type, breed, & ages of each pet:
Are your pets spayed or neutered?
Yes  No  N/A  If no, why not?
Current Vet's Name: Vet's Telephone Number: *What other pets have you had in the past 5 years?
What happened to them?
*Will this pet be an inside or outside pet?
Inside (sleeps in your house)  Outside (sleeps outside in dog house or barn, etc.)   If your answer is "outside", please stop here. We do not believe dogs belong outside fulltime and therefore, can not adopt this dog to you. Please visit your local shelter instead. Thank you. *Do you have a fenced yard?
Yes  No  If no, and are adopting a dog, are you willing and able to walk your dog at least 3 times per day - rain or shine - so that your dog can get the exercise and potty breaks he/she needs?
Yes  No  *Does everyone in your household want to adopt this pet?
Yes  No  *What are the main reasons for adopting this pet?
Please initial after each statement below. By initialing the statement you are agreeing that you have read it, understand it, and agree with our terms.
*By adopting this pet you are agreeing to have this pet as an indoor household companion only. *You understand that by adopting this pet you are making a commitment to take care of this pet for the rest of his/her life, which could be up to 15-20 years. *You understand that there are expenses required with owning a pet. They need annual exams & vaccinations. Dogs need annual testing for heartworms & on heartworm/flea prevention monthly. They need high quality food & training. If adopting a puppy, you understand that it takes a lot of work, patience, and commitment to housebreak and train your puppy good manners. If this pet is not yet spayed/ neutered, you shall have this pet sterilized by a licensed veterinarian within 30 days of adoption. That failure to do so is a simple misdemeanor under Iowa Code Sect. 162.20, Chap. 67.7(2) B & C against the adopter.

I certify that the information that I have given is true and I authorize investigation of all statements made above. I recognize that any misrepresentation of facts may result in losing the privilege of adopting a pet. I understand that AHeinz57 has the right to refuse any request for adoption. In addition, I give permission to AHeinz57 to share information about me that may be obtained during interviews, reference checks, and home visits with other humane organizations.

*Electronic Signature (type name): *Dated: Once you have submitted your application, an adoption coordinator will contact you within 48 hours to set up a home visit.

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Adoption Application

Featured Products/Services

Upcoming Events

Donate a Kuranda Bed!

Drink Wine & Support AHeinz57!