Applicant Information

• Name of puppy you are interested in:
• Applicant(s) Full Name*
  
• Your Address*
  
• Address Line 2
  
• City*
  
• State*
  
• Zip Code*
  

Contact

• Cell Phone*
  
  example: 216-000-1111
• Work Phone*
  
  example: 216-000-1111
• Email*
  

Household

• Select: Married/Single/Partner?*
  ---MarriedSinglePartner
• Do you own or rent your home?*
  ---OwnRent
• How many children are in the family household?*
  
• What are the ages of the children?
  
• How many dogs do you currently own?*
  
Have you ever owned a dog?*
YesNo
What type of breed are the dogs?*

How old are the dogs?*

Where do the dogs sleep?*

If you have a primary veterinarian for your dog(s) please provide their name?*

Please provide the veterinarian's phone number?*

What brand of heartworm prevention do you provide your dog(s)?*

What brand of dog food do you feed your dog(s)?*

• How many hours a day will the puppy be home alone?*
  
• Are you familiar with the breed you are applying for?*
  ---yesnosomewhat
In a short description, please explain your level of familiarity with this breed?*

Character limit: 0/350
• Have you physically visited any other shelters or rescues in the last 6 months?*
  ---YesNo

Employment

• Place of employment*
  
• How long have YOU been employed at this company?*
  
• Your Spouse's/Partner's place of employment
  
• How long has YOUR SPOUSE'S/PARTNER been employed at this company?
  

General Question

• How did you hear about "Heaven to Earth Rescue?"*
  
• In a 100 words (or more) please tell us why you are interested in adopting this puppy?*
  
  Character limit: 1850/1850

Please leave this field empty.