// Adoption Application Form

BIG HEART RESCUE: ADOPTION APPLICATION

Please Note: You must complete the entire application.
Incomplete applications will not be considered.

What is the name of the companion you want to adopt?

Personal Information

Your Name (required)

Your Email (required)

Street Address (required)

City (required)

Province (required)

Postal Code (required)

Home Phone (required)

Cell Phone

Work Phone

Occupation

Employer Name

Your Age

Tell Us About You and Your Home

Why do you want to adopt?

Tell us about your current companion animals:

Are your current companion animals sterilized?
 Yes No

How do your current companions interact with other animals?

What is the name of your veterinarian?

Are your animals' vaccinations up to date?
 Yes No

Do your animals have annual checkups?
 Yes No

Do you have children age 17 or younger living at home?
 Yes No

If yes, what is their experience with dogs?

Which family member(s) would be responsible for the care of this companion?

Please describe your home in detail (house, townhouse, apartment, etc)

Please describe your yard in detail (fenced, type, height, size of yard, etc

Do you own or rent your home?
(If you rent we will require a copy of the rental agreement stating that dogs are pemitted)
 own rent

About Your New Companion

How will your new companion be exercised (for how long and where)?

Where will your new companion sleep at night?

Where will your new companion stay during the day when you are at home?

Where will your new companion stay during the day when you are NOT at home?

How many hours per day will the companion be left alone?

Your New Companion

Please describe your plans for training this new companion

Describe how you deal with a dog displaying behavioral issues

What are you expecting regarding a dog's obedience training when s/he first arrives at your home?

If the companion was on the couch and refused to listen to the Off command, what would you do?

If you returned home to find the companion had urinated on the carpet or chewed a shoe, what would you do?

What is your philosophy regarding crate training?

Briefly describe the perfect dog for you. What characteristics are you looking for? Think about your lifestyle. Are you active, in and out of the home, lots of people or children around, or are you a quiet, sedentary person with few visitors? What personality would best fit your family's needs and lifestyle?

Of the characteristics you listed immediately above, which 2 are the most important?

References

Reference 1: Name

Address

City, Province, Postal Code

Daytime Phone Number

Evening Phone Number

Reference 2: Name

Address

City, Province, Postal Code

Daytime Phone Number

Evening Phone Number

Reference 3: Name

Address

City, Province, Postal Code

Daytime Phone Number

Evening Phone Number

Some Details

The basic needs of a healthy companion (feeding, vet visits, etc) can cost about $500 to $800 per year. Health or behavioural problems can increase this. Does this financial responsibility present a problem?
 Yes No

Have you applied anywhere else within the past year to adopt an animal?
 Yes No

If yes, please state name of agency, rescue, pound etc and when

Are you prepared to allow a representative from Big Heart Rescue to conduct a home visit before and after the adoption has been completed
 Yes No

My signature below indicates that I am at least 21 years of age and intend to be the legal owner and the person responsible for the care and well being of any companion I (we) adopt from Big Heart Rescue Society of BC.

In completing this application, I give representatives from Big Heart Rescue permission to contact my veterinarian, references and landlord if applicable.

By completing this document, I give Big Heart Rescue of BC the right to check with other rescue organizations, humane societies, or my vet and/or to share information about my application with these other groups or with my vet.

By completing this document I understand that Big Heart Rescue Society of BC has the right to refuse my application if the application or home situation is deemed not to be a match for the companion applied for.

I also understand that any misrepresentation of the true facts in this application or in the adoption contract will invalidate the adoption contract and will give Big Heart Rescue Society of BC the right to reclaim the adopted companion without refund of the adoption donation.

My name below indicates that I understand these Terms of Adoption and agree to abide by them if I adopt a companion through Big Heart Rescue Society.

Completed by (name):

Date

We would appreciate any other comments you have regarding this adoption:

If you want a copy of the completed form, please PRINT IT NOW before you click the "send" button to submit your application

Animals For Adoption

Happy Tails

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