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District of Columbia
Zip / Post Code
Please list 3 Personal References, relationship to you and phone #s:
First name, last name, relationship, home phone, & cell phone. First name, last name, relationship, home phone, & cell phone. First name, last name, relationship, home phone, & cell phone.
Do you currently own or rent your home?
If you rent, please provide your landlord's contact information.
How many people are currently living in your home?
Which dog are you interested in adopting?
Where did you first see or hear about this dog?
Does everyone in your household agree with you adopting this rescue dog?
Do you have children?
Do young children visit your home on a regular basis?
Are you committed to constant supervision of this dog around young children?
Are you employed?
How long have you lived at your current address?
If less than 2 years, please provide previous address and number of years there.
Describe your home, yard, and neighborhood.
EXAMPLE: *Approximate square footage. *Is your yard fenced in or open? *Social description of your neighborhood (i.e. city, urban, farm, etc...).
Do you currently have any pets?
If yes, please describe. (What species, breeds, ages, and genders, etc...)
Do you have a veterinarian?
If yes, please provide their name and phone number for a reference.
Are/were your pets up-to-date on vaccinations?
Are/were your pets spayed/neutered?
Have any of your pets had behavioral issues?
If yes, please explain the issue and how you addressed it.
Have you ever had to find a new home for one of your pets?
If yes, please explain what happened.
Have any of your pets required emergency care within the past 5 years?
If yes, please explain what occurred and the outcome.
How many hours per week do you work outside of your home?
Approximately how many hours per week will this dog be left alone?
Where will this dog be in your home when you are away?
Can you afford a bill of $200-$400+ for emergency services?
What type and brand of food do you plan to feed this dog?
How much do you plan to spend on your pet in a year?
How much time are you prepared to allow for your new pet to adjust to your home?
Are you committed to providing a responsible home for your pet's entire life (10+ years)?
On a scale of 1-10 (10 being very experienced), how experienced would you say you are at training a dog?
What type of training/disciplinary techniques do you use with your pets?
What type of training and activities do you plan to do with this dog?
What would you do if this dog develops a behavioral problem?
i.e. barking, digging, chewing, aggression, etc...
Please describe the dog that would best fit you and your family:
i.e. personality, energy level, size, etc...
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Every Little Bit Helps - $10
Feed Me - $25
Healthy & Hopeful - $50
Keeping it Real - $100
Doggy Dreamer - $250
Rescue Rockstar! - $500
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Forms & Applications
Contact Hearts of Hope
P.O. Box 798
Rockford, MI 49341
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