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Hounds of the Heartland Adoption Application Form:

Adoption Candidate Information Name:   Age: **Please Select** 18-25 26-40 41-60 over 60 Address:   City: State: AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY   Zip: Phone:   Cell Phone: Employer:   Work Phone: Email Address:       Spouse or Partner Information Name:   Age: N/A 18-25 26-40 41-60 over 60 Address:   City: State: N/A AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY   Zip: Phone:   Cell Phone: Employer:   Work Phone: Email Address:       Non-adult children's names and ages: Number of adults in household and hours they are home: How many hours per day will your Greyhound be alone? None 1 2 3 4 5 6 7 8 9 10 over 10 Where will your Greyhound stay during the day? Who will have primary responsibility for the care of your Greyhound? How long have you considered this decision? Have you read our required reading "Adopting the Racing Greyhound" or "Retired Racing Greyhounds for Dummies"? No Yes If you have children, have you read our required reading "Childproofing Your Dog"? No Yes Are all members of the household in total agreement with this decision? No Yes How did you hear about GPA? Why do you want to adopt a Greyhound? Do you intend to obedience train you Greyhound? No Yes Do you intend to jog/run with your Greyhound? No Yes Names, species, gender, and age of pets you currently own: Do you own any dogs that go outside? No Yes Do you own any cats that go outside? No Yes Veterinarian's name and phone where your pet's medical history and current vaccinations are on file: Veterinarian's Name: Veterinarian's Phone: How long have you used this veterinarian? N/A less than 1 year 1 year 2 years 3 years 4 years 5 years over 5 years Are your pets current on vaccinations? N/A No Yes Do you know what heartworm preventative is? No Yes Is your dog(s) on it? No Yes If yes, what brand for dogs? Is your cat(s) on it? No Yes If yes, what brand for cats? Are your pets spayed/neutered? No Yes If no, why not? List all pets you have owned as an adult: What happened to them and at what age? Please list two personal references (not related to you) with home or cell phone numbers: Name: Phone #: Name: Phone #: Does HoH/GPA have your permission to call your veterinarian(s) and personal references? No Yes Would you be willing to have a HoH/GPA representative visit your home? No Yes Will your Greyhound be kept as an indoor pet and not left outside, in the garage, or confined to a room? No Yes Will you purchase and use a KENNEL/CRATE for your Greyhound to stay in while you are away from home? No Yes Do you have a fenced in yard? No Yes What type of fence? How high is the fence? N/A 3 foot or less 3 - 4 foot 4 - 5 foot 5 - 6 foot over 6 foot tall If no, is there a fenced in area nearby where you can exercise you Greyhound 2 to 3 times per week? No Yes What type of residence? Apartment Condo Duplex Home Mobile Home Town Home Do you: Own Rent How long have you lived there? less than 1 year 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years over 10 years If you rent, are you allowed to have a dog weighing over 50 pounds? No Yes Landlord's Name: Landlord's Phone #: Do you have a swimming pool, lake, pond, or river in or near your yard? No Yes Will you put a lock on your gate to ensure the the Greyhound is not let out or lets itself out? No Yes Do you agree never to allow your Greyhound to run loose? No Yes Greyhounds cannot be tied to any stationary object, as they are able to take off so quickly that they can literally break their necks. Do you agree never to tie your Greyhound off without your constant supervision? No Yes Will you notify HoH/GPA immediately if your Greyhound is ever lost or stolen? No Yes Do you agree to return your Greyhound to HoH/GPA if for any reason you are unable to keep him/her? No Yes Do you agree never to transfer ownership of your Greyhound to anyone without the consent of the GPA? No Yes Will you keep your Greyhound on heartworm preventative every month and continue annual vaccinations? No Yes Do you agree to keep an ID tag (yours and HoH/GPA's) on your Greyhound at all times? No Yes THE FOLLOWING QUESTIONS WILL HELP US IN THE SELECTION OF YOUR NEW GREYHOUND Gender preference: Female Male Either If specific gender is selected, please state reason for selection: Our retired athletes are between the ages of 2 and 9, and weigh between 60 and 85 pounds. Can you be flexible with regards to age and size? No Yes If the gender, color, size, and age you desire is not available, will you consider another Greyhound? No Yes Would you consider one of our special needs Greyhounds? This usually means special medical needs, special foods, allergies, older age, very shy, etc. No Yes Reason: What children or animals will your Greyhound be in contact with that do not reside with you? Please provide us with any additional information you feel is necessary that may help us in the selection of your Greyhound:         HoH/GPA reserves the right to refuse the adoption of one of our Greyhounds to anyone for any reason.         I HEREBY CERTIFY by typing my full name as a digital signature that the information given in this Greyhound Adoption Application is true and correct. Upon adoption, I accept full responsibility for the welfare and care of the Greyhound, releasing the Greyhound's previous owner as well as HoH/GPA and its representatives from any future liability concerning the Greyhound. I understand that HoH/GPA reserves the right to repossess any Greyhound for violation of the Adoption Contract or if the Greyhound should be mistreated. Digital Signature Date: Spouse or Partner Digital Signature Date:     Both signatures required if applicable   Revision.05/23/08

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