Adoption Application

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Before you fill out this application to adopt a rescue dog from Stray from the Heart, make sure you've thought about this decision. Adopting a dog is a meeting of the heart as well as of the mind. It is a lifetime commitment to an animal that will be your loving companion and your best friend. We want to make this decision as easy as possible for you, so if you are not sure you can take such a permanent step, please consider fostering one of our dogs before you adopt to help alleviate the pressure you may feel. Check out our adorable adoptables, then either fill out our foster form or call one of our adoption counselors at 212.726.DOGS and ask how you can become a foster parent to one of our beautiful dogs.

We understand that this application can seem long, but please be assured that all the below information is completely neccessary to completing the adoption process. If you have any trouble with this online form, please complete, print, sign and mail it to:

Stray from the Heart PO Box 11 New York City, New York 10024-0011 Attn: Adoptions

Who You're Looking For Name of dog you're interested in (from web site, flyer or newspaper ad):   If you're not sure, what age of dog would you like to adopt? Puppy Young Adult Senior Doesn't matter Male or female? Male - Neutered Male - Not Neutered Female - Spayed Female - Not Spayed Doesn't matter Size? Small Medium Large Extra Large Doesn't matter What are you looking for in a dog? What do you most like about dogs? What do you like least about having a dog? Who are you adopting the dog for? Myself My Children As a Gift Who will be the primary caregiver of the dog? How soon were you looking to adopt?   General Information Name: Email: Home Address: City: State: >> AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY       Zip:      Home Phone:   Occupation: Employer: Work Address: City: State: >> AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY       Zip:      Work Phone: Are you over 21 years old? Yes No   About Your Home Type of Residence: House Apartment Condo Mobile Home How long have you lived here? If Apt/Condo, what floor? 1st floor 2nd-4th floor higher than 4 Do you have window guards/screens? Guards Screens Both Neither Rent or Own? Rent Own home Other Please list your last previous address and length of time living there.   Please list all those living in residence (name, relation, age) Name Relation Age Please list any companion animals currently living in this household. Name Cat or Dog (breed) Sex Age Spayed/Neutered Cat Dog F M Yes No Cat Dog F M Yes No Cat Dog F M Yes No Cat Dog F M Yes No Cat Dog F M Yes No Cat Dog F M Yes No Does anyone have animal allergies? Yes No   Do you have a backyard or terrace? Backyard Terrace Both Neither If yes, is it enclosed? Yes No If a fenced yard, how high is the fence, how large an area, and what type of fencing was used? If you have no fence, how will your dog relieve/exercise himself?   Have you ever had a dog previously? (Please provide a brief history. If deceased, state name and date of death) Have you ever taken a pet to a shelter? Please explain.   What is your household activity level? Quiet Active Very active Please explain How many hours are you gone a day?   Do you travel often? Yes No Who will care for your pet when you travel?   Do all adults work full time? Yes No How many hours a day will your new dog be alone? Where will your new dog be kept when he is alone? Where will your new dog be kept during the day? Where will your new dog be kept during the night?   What sort of training do you plan on providing? If we could help with training, would you be interested?   Who will walk your new dog? And how often? Who else will be spending time with your new dog? Is a home visit OK? Yes No   Can you financially afford to care for this dog? Yes No If you became ill, disabled or deceased, who will care for your dog? Name: Phone: Address:   The following information is required so we can verify that you are allowed pets. If you rent, are you allowed pets? Yes No Does your rental agreement specify a size restriction? Yes No Landlord's Name: Landlord's Phone: Landlord's Address:   References Please provide names, relationship and phone numbers of 2 people not related to you Reference 1: Reference 2:   Do you have a local veterinarian? Yes No Vet's Name: Vet's Phone: Vet records are under the name of:   How did you find out about Stray from the Heart?   Please provide any other information that may be helpful for us to know when reviewing your application   DONATION - Stray from the Heart requests a donation ranging bewteen $200-250. Is this acceptable to you? Yes No I certify that the above information is true and accurate to the best of my knowledge, and I understand that completion of this form in no way guarantees my ability to adopt a dog. I further understand that completion of this form is only the firt step in the adoption process and that, should I wish to further this process, and in-home screening will follow. ..................................................................... signature date Home Phone: Work Phone: IMPORTANT Note: Before you press submit, please print out this form. We will need it completed & signed prior to a successful adoption.

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