adopt now

Adoption Application

There are two ways to send us your adoption application:

You may download our Adoption Application and send it to us via e-mail to info@hbith.org

You may proceed to fill out our online application below and someone will contact you.

Thank you for your interest in adopting your next loving pet from HOMEWARD BOUND IN THE HEARTLAND ANIMAL RESCUE INC

HOMEWARD BOUND IN THE HEARTLAND ANIMAL RESCUE INC ADOPTION APPLICATION AND AGREEMENT

PLEASE NOTE: Pets can live on average between 15-25 years. Basic Maintenance (Food, Litter, Grooming etc) can range $40 and up per month. An annual vet check and vaccinations could average $60 and up. We require all adopted animals to be spayed/neutered with adoption. Please also understand that by completing this application this is merely the first step towards adopting from HBH. By submitting this application, you are neither guaranteed nor obligated to adopt. This is merely the beginning of a process that will include vet references, person/phone interviews, and a home visit.

Adopting:
Date:
MM slash DD slash YYYY
First Name:*
Last Name:*
Drivers License or State ID#:
Email:
D.O.B.
MM slash DD slash YYYY
Occupation:
Street Address:
City:
State:
ZIP Code:
Home Phone:
Work Phone:
Cell Phone:
Best Time To Call:

: Hours

Minutes

AM/PM
How long have you lived at your present address? (Years & Months)
***IF RENTAL PROPERTY, PLEASE PROVIDE LANDLORD & LEASE INFO AT THE BOTTOM***
Do you own or rent your home?

Own

Rent
Select the type of Dwelling you live in:

House

Apartment

Condo

Duplex

Townhouse
Describe Your Home:
If you rent your home, please provide property info:
Company/Property Name:
Contact Name:
Phone:
Please list all people currently living in household:
Name:
Gender:
Age:
Name:
Gender:
Age:
Name:
Gender:
Age:
Name:
Gender:
Age:
If you move, what will you do with this pet?
Where will this pet be kept:
During the day:
During the night:
When nobody's home:
When on vacation:
On average how many hours will this pet be left alone each day?
Does anyone in the household have allergies to dogs/cats?

Yes

No
Who will be responsible for this pet? ***Note*** No child under 18 years of age canshould be responsible for this pet NO EXCEPTIONS!
Will this dog/cat be:

Indoor Only

Both Indoors & Outdoors
Please provide name and contact information for your veterinarian, or the one you will use with this pet:
Vet Clinic Name:
Address:
Street Address City State / Province / Region ZIP / Postal Code
Phone:
Please list TWO references I may contact regarding this adoption:
Reference #1
Name:
First Last
Address:
Street Address City State / Province / Region ZIP / Postal Code
Phone:
Email:
Reference #2
Name:
First Last
Address:
Street Address City State / Province / Region ZIP / Postal Code
Phone:
Email
Please list all pets you have owned in the last five years:
Please list all pets (cat, dog, etc) including breed, age and gender that currently live in the household: (Name, Species, Breed, Age, Spay or Neuter?, Gender)
If you have lost a pet or it died at an early age or due to an accident, please provide details:
Have you ever sold, given away or euthanized a pet, please provide details:
Have you ever surrendered a pet to a shelter or rescue group? please provide details:
Describe your reason for wanting to adopt a dog/cat:
Do you have any objections to a home visit prior to taking your adopted animal home?

Yes

No
If yes, please explain:
Have you filled out an application with other rescue organizations?

Yes

No
If you answered yes, please list Organizations:
Organization:
Did you adopt?

Yes

No
Organization:
Did you adopt?

Yes

No
If you DID NOT adopt, please explain why:
Are you willing to donate an adoption Fee?

Yes

No
Under no circumstances will this dog/cat/kitten ever be abandoned, or sold, leased, or given away to any pet shop, humane society, pound, shelter, research facility, rescue group or euthanized for behavioral problems. If for any reason and at any time the Adopter cannot or does not want to keep dog/cat/kitten, the Rescuer will be notified immediately PRIOR to any disposition of said dog/cat/kitten. The rescuer then has the option to a) to take back dog/cat/kitten, or b) to help find another suitable home. The rescuer will be allowed to make follow-up phone calls and/or home visits to assure adoption was a successful match. Failure to stay in contact or refusing to stay in contact with Rescuer will be a breach of this contract and Rescuer has the right to terminate this Adoption Agreement and retrieve the adopted animal. If Adopter refuses to surrender adopted the animal, Rescuer will file legal action against Adopter for the return of said animal and Rescuer will be entitled to reimbursement of any and all legal expenses paid out in this action. By submitting this form you are certifying that all information contained above is true and correct. That you are over 18 years of age and the person responsible for making pet decisions in your family. That you are looking to adopt a pet, give it a good and loving home as a pet owner and accept full responsibility for his/her care.
Signature:
Today's date:
MM slash DD slash YYYY
Comments
This field is for validation purposes and should be left unchanged.

adopt now

There are two ways to send us your adoption application:

You may download our Adoption Application and send it to us via e-mail to info@hbith.org

You may proceed to fill out our online application below and someone will contact you.

Thank you for your interest in adopting your next loving pet from HOMEWARD BOUND IN THE HEARTLAND ANIMAL RESCUE INC

***IF RENTAL PROPERTY, PLEASE PROVIDE LANDLORD & LEASE INFO AT THE BOTTOM***

If you rent your home, please provide property info:

Please list all people currently living in household:

Where will this pet be kept:

Please provide name and contact information for your veterinarian, or the one you will use with this pet:

Please list TWO references I may contact regarding this adoption:

Success!

IF RENTAL PROPERTY, PLEASE PROVIDE LANDLORD & LEASE INFO AT THE BOTTOM