Monica's Heart - Online Application

Name:
Address:
City: State: Zip Code:
Home Phone:Home Email:
Work Phone:Work Email:
Time To Reach You
Occupation(s):
Employer:
Employer City: Employer State: Employer Zip Code:
Number of Adults in Household: Number of Children in Household:
Check if Applicable: Infants Toddlers Pre-Teens Teens
Is there anyone living in your home that has pet-related allergies?
Name of Animal Hospital/Veterinarian You Use:
Name of Veterinarian:
Address:
City: State: Zip Code:
Phone with Area Code:
I have given my veterinarian, Dr., my permission to release information to a Monica's Heart representative regarding the care I give my animals.
Digital Signature:
If you have no veterinarian at this time, please give a personal reference that is not a family member
Preference Name:
Address:
City: State: Zip Code:
Phone with Area Code:
Why are you considering adopting a greyhound?
Do you think of a pet as a family member? YES    NO
How did you hear about our adoption program?
Do you presently have other pets living in your house?YES    NO
Please indicate type, age, and sex of pet(s):
List the dogs you have had in the last 10 years.
Give the reasons you no longer have them.
Have you ever relinquished a pet to a humane society or animal shelter?YES    NO
If yes Why?
We recommend the use of a crate as a training and transition tool.
Are you familiar with crate training?YES    NO
If you are not, would you be willing to learn more about it?YES    NO
I understand that the greyhound has never been in a home and will require my time and patience to adjust. (He may chew, dig in the yard, or steal food off counters. He's never climbed up or down stairs, and TV is an unknown.)YES    NO
I understand that the greyhound is bred to be an indoor pet and cannot live outside.YES    NO
I understand a greyhound cannot run loose because it is a sight hound and most sight hounds will instinctively chase any moving object regardless of danger. YES    NO
Do you own a home?YES    NO
If you rent, do you have your landlord's permission to have a dog?YES    NO
Landlord's name: Landlord's phone number:
Do you have a fenced-in yard?YES    NO
If "YES" is the height of your fence at least 4 feet?YES    NO
How would you describe the activity level of your house? (example: very quiet, lots of activity, rather casual, etc.)
Approximately how many hours a day would your greyhound be home alone?
Are you willing and able to modify your daily schedule to accommodate a greyhound's needs, such as going outside into a fenced area or walking on a leash to perform bodily functions at least three times a day?YES    NO
If you were away more than four hours, would someone be available initially to take the dog outside to perform bodily functions?YES    NO
Once you own a greyhound, would you be willing to receive a follow-up visit?YES    NO
Sex Preference M    F Age Preference Date you can accept a dog:

INTENT TO ADOPT
  1. Agree to give $195.00 to Monica's Heart, Inc. to help defray kennel and veterinary expenses for all dogs Prior to adoption. The following medical services will have been performed: spaying or neutering, heart worm test, fecal analysis, rabies vaccination, dhlpp booster, dentistry, nail clipping, as well as a general checkup.
  2. I will see that my greyhound receives medical care as needed as well as its annual vaccinations and spring heart worm test.
  3. I will see that my dog is exercised daily and is leash walked, or let off lead in an enclosed area, at least three (3) times each day to take care of bodily needs.
  4. I agree to maintain my greyhound as an indoor pet.
  5. I will keep my dog's Monica's Heart tag and a collar bearing a tag with my name, address, and phone number on my greyhound at all times.
  6. I will contact my Monica's Heart representative if, for any reason, I cannot keep my greyhound. I will not give my greyhound to a dog pound or animal shelter of any kind.
  7. I am responsible to contact Monica's Heart and let them know if I intend to return the crate or keep it, so that my check can either be deposited or returned to me. I will inform my Monica's Heart representative within 30 days of adoption of my decision regarding the crate.
  8. I will inform Monica's Heart if I move so that my address information can be updated. I certify that all information on this application is correct and that I will abide by the above statements.
Digital Signature:   Date: