ADOPTION FORM

Please fill out this form completely; failure to answer one or more questions may result in your application being rejected.
Completion of this application does not guarantee adoption of an Ace of Hearts dog.

Date:	Name of Desired Dog:
Your name:	Occupation:
Spouse's name:	Occupation:

Names/Ages of Children, if any:



If no kids, do you plan on having children in the future?

Yes        No   

Any other occupants in home:





Your home address:

Street:   

City, State:   

Zip Code:   

Your phone number:

Daytime   

Evening   

Your email address:   


1.   Type of dwelling:

House     Condo    Apt.     Other


2.   Do you rent or own?

Rent        Own   

If renting, do you have your landlord's permission to have a dog?

Yes        No   

Landlord's name and phone number:




3.   What are your primary reasons for wanting a dog?

Companion for you     For your kids

Gift     For other pet     Watchdog

Other:




4.   If you have children, please describe their previous experience with dogs:



5.   If your children did not want a dog, would you be interested in adopting one for yourself?



6.   Does anyone in your household have allergies?

Yes        No   

If yes, describe:




7.   Do you have a pet now?

Yes        No   

     How many?   

     Type of Pet(s) (if dog, list breed)  

     Age(s)   

     Sex(es)   


Other pets?



8.   Are your pet/s spayed/neutered?       Yes   No

     Have you ever allowed an animal to breed?    Yes        No   


9.   Is there anybody home during the day?

Yes        No   

    Who?

10.   When will the dog be inside?



Outside?



11.   About how many hours a day will the dog be left alone?



Where will the dog stay when he/she is home alone? (please be as specific as possible; i.e., run of the house, a specific room, a crate, etc.)



12.   Where will the dog sleep at night? Dog House Garage

If inside, where exactly?

Kitchen Master Bedroom Spare room

Laundry room Run of the house Other

If other, or if you have additional comments on where the dog will sleep, please specify:



13.   What rooms are off limits to the dog?



14.   What outside areas are available to the dog?

Fenced yard Enclosed patio Garage
Balcony Dog house Unfenced common area Other

15.   Do you have a doggie door?

Yes        No   

16.   Type of fencing? (Chain link, wood, block wall, etc.)



17.   Height of fence:



Highest point   

Lowest point   

I have recently inspected my fence and it is in good condition.
    No   

The fence is intact on all sides and is at least 5 feet from ground level in all areas.
    No   

I promise to inspect my fence thoroughly before the home visit and make necessary repairs for the safety and well being of our new pet.
    No   

18.   Are there gates?

Yes        No   

   How many gates?  

   How high?

19.   Is there any type of lock on the gate(s)?

Yes        No   

Type of lock (padlock, key, latch, etc.):  

20. If no locks, would you be willing to install them prior to placement should this application be accepted? Yes        No   

21. Who has access to your yard?

Gardener Poolman Utility Neighbor Other

If other, please explain:


22. Preferred level of exercise with dog?

Couch potato Short walks

Vigorous walks Hike or jog regularly

23. When you go on vacation, who will care for the dog? (Friend, kennel, dog sitter, etc)



24. What kind of food will you feed the dog?

Brand of kibble:  

Canned:  

Other:  


25. Do you have a regular vet?

Yes        No   

Name of vet:  

Would you like a referral to a vet?

    No   

26. Who will groom and bathe your dog?



27. Would your dog wear a collar?

Yes        No   

When?  

28. Would you allow your dog to wear a permanent Ace of Hearts I.D. tag?

Yes        No   

29. How would you rate your level of dog owning experience?

First time owner Beginner

Intermediate Advanced

Other:



30. How would you discipline your dog if he or she misbehaved?



31. How would you train this dog?

Obedience class Hit with newspaper Firm verbal commands

Clicker/hand signals Other

If other, please explain:



32. How do you normally walk your dog?

On leash Off leash When on leash do you normally use:

Collar only Choke chain Harness Other



If other, please explain:



33. Are you willing to live with hair on the furniture, stains on your rugs, a warm body on your bed, and an animal that might be destructive at times?

Yes        No   

34. Pets are an investment of your time and money. Can you afford to provide medical care, grooming, proper diet, shelter and exercise for your new pet?

Yes        No   

35. Are you able to make a long-term commitment to care for your pet for its entire life span, which could be as much as 10 to 20 years?

Yes        No   

36. What would happen to your pets if you moved?

Locally?



Out of State?



Out of the Country?



37. Which of the following reasons might prompt you to give up your dog? (Check all that apply)

   Excessive barking    Biting    Digging

   Moving    Divorce    Poor watchdog

   Destructive chewing    Financial Problems    Occasional accidents indoors

   Growling at guests    Excessive vet bills    Shedding

   Allergies    New spouse/partner doesn't like dog   

   Aggressive on leash None of the above

Comments:





38. Please list pets you have owned since you have been an adult and the length of ownership; if they are no longer with you, please provide an explanation:



39. How did you find out about our adoption program?



40. Do you or any of your household members smoke cigars or cigarettes? If yes, which areas of the home do you or your household members smoke in?



41. Why are you interested in adopting from a rescue?



Please read and initial each statement below.

I understand that a home visit is required prior to final placement.

I understand that a home visit does not guarantee placement.

I CAN make a donation of at least $350 to help rescue, provide medical care, spay and neuter, board and place other abandoned dogs. (Inability to make a donation does not disqualify an applicant from consideration.) I understand that any donation or contribution is a gift freely given, not a purchase price for a dog.

I CAN make a partial donation to help rescue, provide medical care, spay and neuter, board and place other abandoned dogs, and will then put in volunteer hours to match the $350. (Inability to make a donation does not disqualify an applicant from consideration.) I understand that any donation or contribution is a gift freely given, not a purchase price for a dog.

I agree to provide my own collar, leash, choke chain or harness, and personal ID at the time of completing the adoption contract.


Ace of Hearts reserves the right to refuse adoption to any applicant for any reason. This questionnaire becomes part of our contract.



Please list the name of the dog you're interested in again, and tell us why you're interested in this particular dog.



THANK YOU! Please press 'submit' to send us this form; we will get back to you as soon as possible. Be sure to press 'submit' only once!

  

PLEASE NOTE -We occasionally experience problems with our online application form. If you encounter any difficulties when trying to submit your application, please send an email to our webmistress (IMPORTANT - please let her know the EXACT wording of any error message you receive). If the form seems to go through fine, but you do not hear from us within 3 - 4 days, please send an email to Dogsfromheaven@aol.com to ensure that we did receive your application.
Thanks for your patience!
If the online form doesn't work for you, please copy and paste the entire form into an email and send to: Dogsfromheaven@aol.com
OR CLICK HERE TO DOWNLOAD A PRINTABLE APPLICATION FORM AND FAX IT TO
310 652 8688








Our dogs are listed with


To see other dogs available through local shelters, follow the links below:

L.A. Animal Services
Los Angeles County Animal Care & Control