APPLICATION TO ADOPT

PLEASE COMPLETE THE ENTIRE APPLICATION - DO NOT SKIP QUESTIONS.

At this time, we do not accommodate out of the area adoptions, and offer local Los Angeles area adoptions only.

I VERIFY THAT I WILL ANSWER ALL OF THE QUESTIONS TRUTHFULLY. I UNDERSTAND IF ANY OF THIS INFORMATION IS FOUND TO BE FALSE, EZ HEART AND SOUL RESCUE MAY CONFISCATE THE ADOPTED ANIMAL. WE RESERVE THE RIGHT TO REFUSE PLACEMENT OF ANY ANIMAL.  

***WE REQUIRE A HOME VISIT AND REQUIRE THAT ALL MEMBERS OF THE FAMILY (INCLUDING OTHER PETS) VISIT WITH THIS ANIMAL PRIOR TO ADOPTION. BY SUBMITTING THIS APPLICATION TO EZ HEART & SOUL RESCUE, YOU ACCEPT, ACKNOWLEDGE AND WILLINGLY ALLOW SUCH VISIT.***

Full Name *
Full Name
Birth Date *
Birth Date
Full Name of Spouse/Partner
Full Name of Spouse/Partner
Partner's Birth Date
Partner's Birth Date
Home Address *
Home Address
Home Phone *
Home Phone
Work Phone *
Work Phone
Cell Phone *
Cell Phone
In what kind of residence do you live? *
Do you own or rent? *
Where do you plan to keep your dog during the day? (Check all that apply)
Will pet be crated? *
Crated at night? *
Please describe your yard:
Fence type:
If you have no fence, how will you exercise your pet?
Include: Name and type of pet / Age / Sex / Spayed or neutered / Kept inside or outside / How long owned / What happened to pet
If your pet did have behavior problems, what would you do? *
Veterinarian phone number
Veterinarian phone number
Why do you want a pet? *
What reasons would cause you to consider giving your adopted pet back to EZ Heart & Soul Rescue, or cause you to no longer be willing to commit to him/her? (Check all that apply.) *

PLEASE NOTE: A review and response of your submitted application may take up to 10 days.