Confident Companion Adoption Application

Confident Companion Adoption Program

Today's Date*
MM slash DD slash YYYY
Is there a specific "Confident Companion" program dog you're interested in? If yes, please provide name/description.*
If you named a specific dog above, why are you interested in this dog?
First Name*
Last Name*
Are you at least 18 years of age?*
Facebook Name
Phone*
Email*
Nearest Major Cross Streets*
Address (plus apartment number if applicable)*
Street Address City State ZIP Code
Do you own or rent?*
Landlord name/phone # (if applicable)
How did you hear about HARTT's Confident Companion Adoption Program?*
Please tell us more about why you are interested in adoption a shy or undersocialized dog from HARTT.*
Which of the following applies?*
- I live in an apartment or condo
- I live in a single family home
What types of shy dogs would you be willing to consider adopting?*
- Small Dogs (under 20 pounds)
- Medium Dogs (20-50 pounds)
- Large Dogs (50+ pounds)
- Senior dogs
- Male dogs
- Female dogs
- Hospice dogs (limited life expectancy due to terminal illness or advanced age)
- Dogs who do not get along with other animals
- Dogs who get along well with other animals
Please tell us about the other humans who share your home, including regular visitors. Please provide age, gender and how they feel about adopting a shy dog.*
Please tell us about the animals who share your home. Please provide breed (or best guess), gender, spay/neuter status, age, and temperament.*
Have you owned and kept pets in your household the last 5 years who are not listed above? If so, please provide Name, species and breed, age, and what happened to the pet (died, ran away, gave to a friend, etc.)*
Have you ever adopted a shy, skittish or undersocialized dog before? Please tell us about those experiences.*
Current employer, occupation, location employer/company you work for:*
If retired or not currently working, please provide former occupation.
Tell us about the work hours of the adults in your household.*
Where will the dog be kept when you are away from home?*
Where will the dog be kept when you are home?*
Where will the dog be kept during bedtime?*
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: . 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 the fence?*
Do you have a doggie door?
- Yes
- No
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.*
With a skittish dog, at time 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.*
Please upload a current photo of yourself for our records!
Max. file size: 32 MB.
I understand that shy and skittish dogs take a great deal of patience to adapt to their surroundings. What may take other dogs days or weeks for other dogs to learn may take months or years with a shy dog.*
I agree to take regular photos and videos of my Confident Companion program dog and communicate regularly with HARTT, so that they can assist me in meeting the emotional needs of my newly adopted family member.*
I agree to notify HARTT if there is a change in the occupants of my home, my address, or a material change in my ability to care for this dog. HARTT will assist with this transition in a manner that is safe and most suitable for your family and your dog.*
I understand that shy dogs will likely be an extreme flight risk for the rest of their lives, and I agree to follow all protocols required by HARTT as shared with me at the time of the adoption (locked gates, door barriers, martingale collars, trackers, waist leashes, transport crates) for the life of this animal.*
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 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 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 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 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.*
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 to a home visit prior to the adoption being finalized, to assure the environment is suitable.*
I agree to never let the dog off-leash when outside of a secure, fenced yard at least 6’ high.*
Signature*
CAPTCHA

Name	Gender	Approx. age	Household Member or Visitor?	Remarks

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)