Adoption Application

Your Name *

First

Last

Email *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Spouse/Partner Name *

First

Last

Name/ Ages of Children, if any: *

Your Age *

Your Occupation *

Spouse/Partner Age *

Spouse/Partner's Occupation *

Any other occupants in home: *

Type of dwelling *

House Condo Apartment Other

Do you own the property you live in? *

Yes No

If renting, do you have your landlord’s permission to have a dog? *

Yes No

Landlord’s name and phone number: *

Number of hours the dog will be left alone daily *

Where will the dog be kept during the day? *

Where will the dog be kept at night? *

Do you have a fenced yard? *

If yes, type of fence: *

Height at lowest point: *

Does your homeowners/renters insurance have any breed restrictions that would affect you adopting this pet? *

Yes No

Do all household members agree to you adopting this pet? *

Yes No

Please list past dog experience and what happened to those animals. *

Do you have children living in the home? *

Yes No

If yes, please list their age(s): *

Please list all other animals living in the home: Type of Pet (Cat/Dog) & Breed? Age? Male/Female? Spayed/Neutered? Name? *

Is there a particular dog on our website you are interested in? *

Yes No

If yes, please provide name: *

If the particular dog you're interested in is no longer available or not the best fit, are you interested in continuing the adoption process to find the right dog? *

Yes No

Please describe the temperament, activity level, and special qualities you are looking for in a dog: *

Are you: *

First Time Owner Experienced Dog Owner

What type and brands of food do you feed or fed your dogs? *

Are you aware of the costs of owning a dog, such as medical care, vaccinations, license fees, etc.? *

Yes No

Are you aware of county leash and animal license laws? *

Yes No

If the dog you're interested in is not housebroken or trained, exhibits separation anxiety (barking, destroying property, other unacceptable behaviors), or exhibits aggressive tendencies, what are your plans to remedy unwanted behaviors? Are you willing to spend the time necessary working with the dog to correct these behaviors? *

Who will care for the dog when you travel? And what will happen if you can no longer care for the dog or your relationship status is to change? *

Vet references *

Would you agree to a home-check visit before your application is approved? *

Yes No

Have you ever had to give away an animal? *

Yes No

If yes, what happened to that animal? *

Have you ever been investigated by Animal Services? *

Yes No

If yes, please explain: *

Do you understand that there is a tax-deductible adoption fee for this animal? *

Yes No

Please state the amount you are willing to donate. $ *

I am at least 21 years old. All of the information I have given above is true and complete. This dog will reside in my home as a pet and will not be strictly kept outdoors. I will provide it with adequate food, water, shelter, training, affection, and medical care. I am able and willing to spend the time and money necessary to provide training, medical treatment and proper care throughout the entire life of the dog. I understand that the King of Hearts Foundation is not responsible for the accuracy of information received about the temperament, habits, or physical conditions of dogs available for adoption prior to their arrival at King of Hearts Foundation. I understand that it is my responsibility to see and evaluate the dog myself before agreeing to adopt it. I am aware that there will be a rescue fee should I decide to proceed with adopting an animal from King of Hearts Foundation. Please understand that King of Hearts Foundation will disclose all known issues, health or behavioral, known or as provided to King of Hearts Foundation by the animal’s previous owner or the shelter from which the animal was originally rescued; thus, there are no guarantees regarding an animal’s health, level of training, or other unknown past or future tendencies. I agree to return the dog to King of Hearts Foundation in the event that I am not able to keep the dog. I will not surrender this animal to any shelter, family, friends or sell the dog without informing the King of Hearts Foundation. By signing and submitting this form, you agree to the terms and conditions outlined above. I wish to visit the King of Hearts Foundation and/or participate in activities sponsored by the the King of Hearts Foundation (KOHF). I understand that I do so at my own risk. I hereby release and waive all claims against (KOHF) and any entities affiliated with the foregoing from liability for any and all loss, damage, injuries, claims, demands, lawsuits, expenses, and any other liability or any kind, of or to me, my child(ten), or any other person, directly or indirectly arising out of, or in connection with visit my visit to the (KOHF) of participation in any activity sponsored by (KOHF). I agree that this Waiver and Release is untested to be as broad and inclusive as permitted by the laws of California and that this Release and Waiver is governed by and will be interpreted according to the laws of California. I understand that should any part of this Release and Waiver by ruled invalid by a court, the other parts will remain valid and continued to be in effect. *

I understand by that checking this box, I am submitting my electronic signature.

King of Hearts Foundation Adoption Application

Personal Information

Housing Information