Ace of Hearts Adoption Application
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.
Name of Desired Dog:
Email Address. Failure to provide email address may result in rejection of application.
Phone Number. Failure to provide phone number may result in rejection of application.
Your address (street, city, zip):
House Number, Street, City, State, Zip
Name(s)/Ages of Children, if any, or future children:
If no children, please tell us if you plan on having children in the future
Any other occupants in home:
Type of dwelling
If renting, do you have your landlord's permission to have a dog (Yes/No)
Landlord's name and phone number:
What are your primary reasons for wanting a dog?
Companion for you
For your kids
For other pet
If you have children, please describe their previous experience with dogs:
If your children did not want a dog, would you be interested in adopting one for yourself?
Does anyone in your household have allergies?
If yes, describe:
Do you have a pet now?
Type of Pet(s) (if dog, list breed) and how many?
Are your pet(s) spayed/neutered? (Yes/No)
Have you ever allowed an animal to breed? (Yes/No)
Is there anybody home during the day? (Yes/No)
When will the dog be inside?
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.)
Where will the dog sleep at night?
If inside, where exactly?
Run of the house
If other, or if you have additional comments on where the dog will sleep, please specify:
What rooms are off limits to the dog?
What outside areas are available to the dog?
Unfenced common area
So you have a doggie door?
Type of fencing? (Chain link, wood, block wall, etc.)
Height of Fence (Highest point and Lowest Point):
I have recently inspected my fence and it is in good condition:
The fence is intact on all sides and is at least 5 feet from the group level in all areas:
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.
Are there gates?
How many gates?
Is there any type of lock on the gate(s)?
Type of lock (padlock, key, latch, etc.):
If no locks, would you be willing to install them prior to placement should this application be accepted?
Who has access to your yard?
If other, please explain:
Preferred level of exercise with dog?
When you go on vacation, who will care for the dog? (Friend, kennel, dog sitter, etc):
What kind of food will you feed the dog? (Brand of kibble, canned, or other):
Do you have a regular vet?
Name of vet:
Would you like a referral to a vet?
Who will groom and bathe your dog?
Would your dog wear a collar?
Would you allow your dog to wear a permanent Ace of Hearts I.D. tag? (Yes/No)
How would you rate your level of dog guardianship experience?
First time Guardian
How would you discipline your dog if he or she misbehaved?
How would you train your dog if he or she misbehaved?
Hit with newspaper
Firm verbal commands
If other, please explain:
How do you normally walk your dog?
If other, please explain:
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)
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)
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)
What would happen to your pets if you moved locally?
What would happen to your pets if you moved out of state?
What would happen to your pets if you moved out of the Country?
Which of the following reasons might prompt you to give up your dog? (Check all that apply):
Digging/Destructive chewing/occasional accidents indoors
Financial Problems/Excessive vet bills/Moving
Growling at guests
New spouse/partner doesn't like dog/Divorce
Aggressive on leash
None of the above
Please list pets you have been guardian of since you have been an adult and the length of guardianship; if they are no longer with you, please provide an explanation:
How did you find out about our adoption program?
Why are you interested in adopting from a rescue?
Do you or any of your household members smoke cigars or cigarettes? (Yes/No)
If yes, in what areas of the home?
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 $400 to help rescue, 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 NOT make a donation of at least $400 to help rescue, provide medical care, pay 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 agree to provide my own collar, leash, choke chain or harness, and personal ID at the time of completing that adoption contract.
A description of the section goes here.Ace of Hearts reserves the right to refuse adoption to any applicant for any reason. This questionnaire becomes part of our contact.
Please list the name of the dog you're interested in again, and tell us why you're interested in this particular dog.
Do Not Fill This Out