Willing Hearts Dalmatian Rescue, Inc.
P.O. Box 11 - Royersford, PA 19468
(610)948-5898
Our Heart is in the Right Spot!

Adoption Questionnaire

Thank you for applying with Willing Hearts Dalmatian Rescue (WHDR)

Our adoption fee is $250.00

Please completely fill out the application or it will not be considered for approval. Thank You.

Click here to download the application in a Word document.

Date
Name of Adopter(s)
Age(s)
Street Address
City, State, Zip
E-Mail Address
Can WHDR contact you by e-mail for WHDR related information? yes no
Home Phone
Mobile Phone
Primary Adopter Employer
Primary Employer City
Primary Employer Phone
Secondary Adopter Employer
Secondary Employer City
Secondary Employer Phone
Best Time to be Contacted
Which dog are you interested in?
If no specific dog, what age/sex/breed?
Do you prefer a non-shedder? yes no
Why do you want to adopt a dog?
Do you consider yourself/family to be active
in such a way that it would include a dog?		 yes no
Please Explain
What dogs/cats do you currently have? Breed M F Age
Spayed or Neutered? yes no
Indoor Outdoor
Breed M F Age
Spayed or Neutered? yes no
Indoor Outdoor
What happened to your animal?
If you don't have a dog or cat now, what dogs/cats have you had in your adult life? Breed M F Age
Spayed or Neutered? yes no
Indoor Outdoor
Breed M F Age
Spayed or Neutered? yes no
Indoor Outdoor
How do your dogs/cats get along with other dogs?
Ever train in obedience? yes no
What discipline method do you use, how do you correct your dog(s)?
Are you willing to train in obedience? yes no
What dog food do you use?
How Often?
Wet or Dry?
Do you use Heartworm Preventative? yes no
What kind?
Have you ever breed a litter? yes no
Have you ever adopted/rescued a dog/cat before? yes no
From who? (Name and Number)
Have you ever returned a dog to a shelter? yes no
If yes, please explain.

Many vets require that we have your permission to speak with them. Please call and let them know that a representative of Willing Hearts Dalmatian Rescue will be contacting them.

Thank you
Name of Veterinarian
Veterinarian Address
City, State, Zip
Veterinarian Phone
Personal Reference #1
City
Personal Reference Phone
Personal Reference #2
City
Personal Reference Phone
Size of yard?
Is it Completely fenced? yes no
Fence Height?
Fence type?
If you do not have a fence, how will the dog be contained?
Do you have a dog kennel? yes no
What type?
What kind of accommodations do you have for the dog in the hot/cold weather?
Is anyone home during the day? yes no
How many hours would the dog be left alone?
Where will the dog stay during the day when alone?
Do you own or have you used a crate?
Metal Plastic
What are the ages of children in contact with the dog?
Please describe any neighbors that the dog would be involved with (do they like dogs?, have children (ages), have dogs or cats?)
Is there any asthma or allergies in the household to dogs or cats? yes no
If yes, how severe?
Do you own or rent?
How long at address?
Type of home(single family, apartment, condo, trailer, townhouse, etc..)
Are there any pet restrictions? yes no
Name and number of Park Manager if applicable
Are you willing to have a WHDR member visit your home before and after adoption? yes no
If you rent, a letter of permission from your landlord will be required prior to adoption.
Name of Landlord
Landlord's Address
City, State, Zip
Landlord's Phone
Do all parties (if more than 1 adult in the house) want a dog? yes no
Adopted pets need an adjustment time. Are you willing to give the new dog at least one month trial to ensure proper adjustment? yes no
What would, in your opinion, constitute a reason for not keeping the dog?
We are always in need of temporary homes for our rescue dogs. Would you be willing to foster a needy dog/puppy if it is compatible with your lifestyle and other pets?
For how long?
Until placed?

Please enter any comments or questions here:

I/We understand that if we cannot keep the dog it will never be sold, given away, traded, abandoned, or otherwise disposed of to any person(s), dealer, retailer, auction institute or other entity for ANY reason. I/We understand the dog MUST be returned toWilling Hearts Dalmatian Rescue (WHDR), no exceptions. I/We agree that we will notify a member of WHDR in a timely manner to make arrangements for the return of the dog. I/We agree I/we will humanely house and care for the dog until arrangements can be made with WHDR. If I/We do not return the dog to WHDR we agree to pay $500 to WHDR for violation of this contract.

Signature Line - Please type adopter(s) names as a signature that all information provided is true and accurate and you agree to the terms stated.

Once you hit submit your application will be sent through e-mail to WHDR, please allow adequate time for our volunteers to review your application. Thank You!