Adoption Application | Heartland Cavalier

PLEASE REVIEW BEFORE SUBMITTING

Thanks for your interest in adopting! Applicants must live within driving distance of Fort Wayne, Indiana and be willing to bring any current dogs to the foster dog's home for a meet and greet (in Fort Wayne) in order to adopt from us. We require all applicants that have owned a dog to have them up to date on vaccines, be neutered/spayed, and use heart worm preventative regularly. We do not adopt to households using invisible fences, shock collars, prong collars, or choke collars. We do not adopt to an intermediary; we place dogs directly in their forever homes.

1a. First name

1b. Last name

2. Birthday

Month

Day

Year

3. Email

4. Phone

5a. Address

5b. City, State

5c. Zip Code

6. Occupation

7. Number of hours you work outside the home per week

8. Spouse's name

9. Spouse's Occupation

10. Number of hours spouse works per week outside the home

11. Please describe your typical daily routine

12. Please list the names and ages of all people living in your household (excluding spouse)

13. Are any members of your household allergic to dogs?

Yes

No

14. Please list the names of any dogs, cats, or other pets living in your household. Include ages and breeds if known.

16. Please list how many years you have been at your current residence.

17a. Please indicate whether you own or rent your residence

Own

Rent

Other

Does your home have stairs that a dog would have to navigate to get to their sleeping area and pottying area? Please provided details.

18. Does your home have a yard? If so, what size?

19. Does your home have a fence? If so, what type?

20. Please list all previously owned dogs and how long you cared for each of them (deceased or rehomed)

21a. Do you agree to allow Heartland Cavalier Connection Inc to contact your veterinarian as a reference? Please list clinic name, contact information, and pet's name.

21b. What type of dog food do you feed your dog/s?

22. Please list all training techniques, training classes, and tools you have used on previous and current pets

23. Have you ever rehomed or surrendered a dog? If so, please describe the circumstances.

24. Why are you interested in adopting a dog at this time?

25. Why are you interested in adopting a Cavalier King Charles Spaniel?

26. When you are traveling, who cares for your dog?

27. Are your dogs allowed on your furniture?

28. Where do your dogs sleep?

29. Do you walk your dogs on leash when they are not on your property?

30. Are you aware that the average costs of medical care for a healthy Cavalier King Charles Spaniel average $600 per year?

31. Are you aware that Cavalier King Charles Spaniels can have a variety of health issues, including mitral valve disease, luxating patellas, corneal ulcers, and syringomyelia?

32. Are you interested in adopting a specific dog?

33. If you have a preference, please list desired dog's age, coat color, and special need status.

Yes, subscribe me to your newsletter.

I agree that if at anytime during the animal’s life if I am unwilling or unable to care for the animal, I will contact Heartland Cavalier Connection Inc to manage rehoming or providing care to the dog.

I allow Heartland Cavalier Connection Inc to visit my home to do a scheduled home visit before I adopt the animal, as well as manage an interaction between the adoptable dog and all animals in my household before an adoption takes place.

I allow Heartland Cavalier Connection Inc to contact my veterinarian for a medical reference.

I understand that accidental animal bites or other injuries to humans and other animals do occur, and agree to hold harmless and indemnify, and protect Heartland Cavalier Connection Inc from any claim or suit filed by anyone as a result of such an incident. In addition, our organization will not be responsible if animal should damage or destroy property belonging to me or others, or shall transfer any disease or internal or external parasites to other animals belonging to me or other animals.

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