1. The most common reason that dogs are turned in to shelters is because their owners are moving. Are you committed to making the necessary adjustments to your life so that this doesn’t happen to you and your dog?_______

2. A dog can live from 10 to 20 years. Are you committed to providing for a dog for that length of time? ____

3. Responsible dog owners see that their dog receives yearly booster vaccines and is kept free of intestinal parasites and heartworms. In addition, dealing with fleas and ticks is a constant battle in Florida. Dog care is expensive. Regular preventative care can cost anywhere from $100-$200 per year. In addition to veterinary care, expenses for food, boarding, grooming, basic obedience training, crates, chew toys, dog beds, collars, and leashes can be expensive. Can you make this financial commitment to your dog?_______ 

4. A dog needs more from its owner than food, water, and shelter. A dog needs to feel part of  the family unit. Will you provide the love and attention a dog deserves for its lifetime?______ 

5. Since many homeless animals have unknown medical backgrounds, are you prepared to take your dog for a complete physical examination within three days of adoption and to provide any   necessary medical care_______   Our veterinarians offer a free courtesy exam by appointment for dogs adopted from our Rescue.  This information will be provided at time of adoption.                                                                                                          

6. Since many homeless animals have unknown behaviors,  are you prepared to provide the necessary patience, time and money to train your dog?_______ 

Section # 1

• Dogs Name ________________________

• Your name____________________________________ Home phone ______________

Cell Phone ________________

• address___________________________  apt#_____ city________________ zip_____

• employer____________________________ work/day phone _____________________

e-mail address_____________________________________

• How long have you lived at this address? _____ Is this the address where the dog will reside?______ If “no”, at what address will the dog reside?_________________________

Do you own or rent? ____________type: house ___apt. ___mobile home ___condo____

• If you Rent - name of apt. complex or landlord __________________________phone#____________

Section # 2

• How many people live in your household?   adults:____   age (s) _______________

children:____  age (s) _____________

• Does anyone have allergies to animals?____                                                                      

• What are your reasons for adopting a dog? gift ___companion___children___guard___other_________________________________

• What made you chose THIS animal for a dog? ___________________________________

• How much time will this dog be left alone in a 24-hour period?_______

• How much time will this dog be outside in a 24-hour period? ______

• Where will this dog be kept when left alone?  crate___ free roam of home___ backyard___

screened porch___ chained___ other__________________________________________

• Is your yard fenced in on all sides? yes___ no___ type of fence? ____________________

• Where will your dog sleep? _________________

• How will this dog be exercised? _________________________________

• If you should move, what will you do with this dog?   bring it back___ give it away___

move with you___ other_________________________________________________

Section # 3

• How many dogs and/or cats have you had in the last five years? ____

• What happened to them? __________________________________

• Do you have any dogs or cats in your home now? ___

• If yes, how many dogs? ___ cats? ___ other? ________________________________

• Name of veterinarian or animal hospital currently used ___________________________

• Are your dogs’ vaccinations current? ___ Are your dogs spayed or neutered?____

• Are you familiar with local dog licensing and rabies vaccination requirements? ___

• Have you ever given up a dog? _________ If so, what were the circumstances?_________

Section # 4

How did you hear about Openheart?__________________________________

____________________________________

Signature     _____________________________