Study Suggests Dog Lovers

3241 E Shea Blvd #416, Phoenix, AZ 85028 info@azhartt.org (602) 601-2604

Study Suggests Dog Lovers

June 26, 2015

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[Retired] Adoption Application and Agreement

Today's Date*
MM slash DD slash YYYY
Which pet are you interested in? (Name)*
Breed*
Gender*
How did you learn about this pet?*
- Adoption event
- Family/Friend
- Petfinder
- Social Media: HARTT's Facebook
- Social Media: HARTT's Instagram
- Visiting HARTT Shelter
- Website: azhartt.org
- Website: "Adopt Me"
- Website: "Rescue Me"
Why are you interested in this particular animal?*
First Name*
Last Name*
Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Cell Phone*
Alternate Phone
Email*
Do you own or rent?*
Landlord name/phone #
Name and relationship of any individuals who will co-own this pet:*
How do these individuals feel about this adoption?*
Employer (company name), occupation/position, and work hours of the adults living in the home:*
Where will the pet be kept when you are away from home?*
Where will the pet be kept when you are home?*
Where will the pet be kept during bedtime?*
If adopting a dog: How have you housetrained dogs in the past to not go potty indoors?*
Do you have a fenced yard? If yes, please provide the following: 1. Height of the fence at the lowest point 2. Fence material (wood, chain link, etc.) 3. Are there any holes, gaps or areas that need repair?*
Do you have a pool? Fenced? How high is fence?*
Please provide the name and number of the vet clinic you have used or intend to use after the adoption:*
If adopting a dog: How will you keep this dog from jumping your fence, digging under your gate, or “door-dashing” when visitors come to the home? Newly-adopted dogs can be nervous and are a flight risk.*
Please provide us with a profile of the PEOPLE (don't forget to list yourself/your partner!) to whom the pet will be exposed on a regular basis, either as a permanent member of your household, or as a regular visitor in your home.*
Name Gender Approx. age Household Member or Visitor? Remarks
Please provide us with a profile of the ANIMALS to whom the pet will be exposed on a regular basis, either as a permanent member of your household, or as a regular visitor in your home.*
Name Species/Breed Gender (spayed or neutered?) Approx. age Household Pet or Visitor? Remarks
Have you owned and kept pets in your household in the last 5 years who are not listed above? If so, provide:*
Name Species and breed Age when they left your home What happened to the pet? (died, ran away, gave to friend, etc.)
What behaviors or circumstances would you not tolerate, that would cause you to return this pet?*
While not all HARTT pets are shy or skittish, some are, especially when acclimating to a new environment. After all, this is why our specialized skills were used to rescue many of the pets who come into our care! At times, it may be necessary to react quickly to shut a door or a gate, or to pick up a dropped leash (although we recommend a waist leash at ALL times, so that this can never happen). Please indicate whether you, or others within your household: 1. use any mobility assistance devices (canes, walkers, wheelchairs, etc), 2. would have difficulty being agile if the need would arise to keep this pet safe, or 3. would have difficulty understanding, recalling or adhering to safety protocols regarding leashing, walking, utilizing door barriers, or transporting a shy or newly adopted pet in a vehicle. None of these items are a barrier by themselves to adopting a pet from HARTT, however it will help us to assess which pet might be a suitable fit for you/your family.*
If selected for the adoption, and if I agree to proceed with adopting this pet, I acknowledge the following (please initial after each item):
I understand that HARTT has done its best to assess the pet’s temperament and health, but not all health conditions or behaviors are evident or present during the time the pet is with HARTT. Animals who are rescued may have underlying conditions from not having received previous proper nutrition and veterinary care. HARTT cannot guarantee that the pet will not manifest or develop behavior or health problems in the future; I understand and I agree to accept responsibility for providing the required care for this pet from the date of adoption forward.*
I agree not to hold the rescue liable for any damage to persons, other animals, or property.*
I agree to keep this pet as a household pet, and to allow him/her to live indoors as a member of my family.*
I understand that if I am adopting a pair of "bonded animals" (ie, HARTT requires them to be adopted together due to the pets' strong emotional bonds with one another) and I become unable or unwilling to keep one of the animals, I must return BOTH animals to HARTT at the same time so that they will remain together and will not be separated.*
I agree to provide good food and fresh water at all times, and to provide all required veterinary care, both routine (vaccinations, etc) and in the event of illness or injury.*
I agree to keep an ID tag with current number on the pet’s collar at all times, and if I change phone numbers, I will update the tag.*
I understand that HARTT maintains all microchip registrations for pets we have adopted, and I agree to notify HARTT immediately if I have a change of address or phone number, so that my microchip record can be updated by HARTT.*
I agree that I will license this pet within 30 days of adoption if residing in Maricopa County.*
I have read the “Escape-Proof Your Dog” document (if applicable) and agree to abide by these terms.*
I agree that if my circumstances change, if I run into problems or if I am no longer to provide a permanent home for the pet, I will contact HARTT immediately.*
If at any point this pet is lost or ends up missing, I agree to IMMEDIATELY contact HARTT, regardless of the hour. HARTT volunteers are experts in lost dog recovery, and we will devote as many resources as possible to recovering one of our lost "Alumni".*
I understand that if I must give up or make alternate arrangements for this pet, I will contact HARTT and make arrangements to return this pet directly to us. I agree that I will not take the dog to a shelter or other pet care or rescue group, and that I will not give or sell the pet to anyone, including a family member, who has not been approved by HARTT (we always want our rescues to come back to us!).*
I agree that if this pet ever ends up lost, in a shelter or found by others, and if the condition of the dog has deteriorated, does not easily correlate to the pet’s age or the period of time the pet was missing, or cannot be supported by recent and appropriate veterinary records and prescriptions, or if it is determined that our safety protocols for keeping shy, skittish or recently adopted pets safe were not followed, I consent to returning the legal, permanent and immediate custody and ownership of the pet to HARTT.*
This adoption fee is non-refundable after 10 days.*
I agree to a home visit prior to the adoption being finalized, to assure the environment is suitable.*
Dogs: I agree to never let the dog off-leash when outside of a secure, fenced yard at least 6’ high.*
Signature of adopter*
Date*
MM slash DD slash YYYY
CAPTCHA

Name	Species/Breed	Gender (spayed or neutered?)	Approx. age	Household Pet or Visitor?	Remarks

Name	Species and breed	Age when they left your home	What happened to the pet? (died, ran away, gave to friend, etc.)

Date	Time	Location (Be specific as possible)

Study Suggests Dog Lovers

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