Every 10 Seconds, a Dog Enters a Shelter.

Heartworm Project Adoption Application

Please understand that we do not adopt animals on a first-come, first-served basis, but rather we select the home that we believe will be the best match for the animal.

Please complete all appropriate fields in the form below. Fields marked with an ‘_*‘ are required.

Contact Form

Step 1 of 8

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Personal Information
Name*
Last Name* First Name*
Spouse/Partner/Roommate Last Name
Spouse/Partner/Roommate First Name
Address*
City*
State*
Zip Code*
Home Phone (xxx-xxx-xxxx)*
Work Phone (xxx-xxx-xxxx)
Cell Phone (xxx-xxx-xxxx)
Email*
Occupation*
Employer*

1st Personal Reference
Name*
Name
Relationship*
Phone (xxx-xxx-xxxx)*
Address*
City*
State*
Zip Code*
2nd Personal Reference
Name*
Name
Relationship*
Phone (xxx-xxx-xxxx)*
Address*
City*
State*
Zip Code*

Your Veterinarian
Do you currently have a veterinarian?*
- Yes
- No
Name
Name
City
State
Phone (xxx-xxx-xxxx)
Can we contact your veterinarian for a reference?
- Yes
- No
If you do not CURRENTLY have a vet, but have had a vet in the past, please provide
Name
Name
Phone (xxx-xxx-xxxx)
If you have used multiple vets, please provide contact information for all of them
Pets Interested In
Which pet(s) on the site are you interested in adopting?*
Why do you think this pet would be a good addition to your family?*

Home Visit
Will you agree to a home visit?*
- Yes
- No
By selecting yes, you agree to allow a representative of the Heartworm Project to visit your home by appointment as a part of the application or the follow-up process.
Application Information
Is all the information your provided true and correct?*
- Yes
- No
By selecting yes, you agree that all the information provided in this application is true and correct, and you will promptly advise the Heartworm Project if any of the information changes.

Heartworm Project Adoption Application

Contact Form

Step 1 of 8

Personal Information

1st Personal Reference

2nd Personal Reference

Your Veterinarian

Pets Interested In

Your Children

Your Dogs

Your Cats

Your Home

Home Visit

Application Information