Adoption Application

Please take a moment to read our policies

DISTANCE POLICY--Caring Hearts Rescue only serves the inner suburbs of the Washington, DC metro area (please see our FAQ page for a definition of this area). If you are not sure whether you live within our service area, please ask before completing our application by emailing us at adoptchr@caringheartsrescue.org.

POLICY ON CHILDREN--We only adopt dogs to homes with children aged 11 and above. This policy exists to protect children from dog bites or other dog-related injuries. We are sorry that we cannot make any exceptions.

General Information

Name *

Address

City *

State *

Zip Code

Day phone number *

Evening phone number

Email Address *

Confirm Email Address *

DOG NAME Which dog are you interested in adopting?: *If you are interested in more than one dog, you do not have to apply seperately for each one--simply list ALL their names here. *

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Is this the first time you have applied for a dog from Caring Hearts Rescue?

Information about Your Family/Household

Members of Your Household (please list everyone that lives in your home, including yourself).

	Name	Age	Relation to Applicant
1.	Name	Age	Relation to Applicant
2.	Name	Age	Relation to Applicant
3.	Name	Age	Relation to Applicant
4.	Name	Age	Relation to Applicant
5.	Name	Age	Relation to Applicant
6.	Name	Age	Relation to Applicant
7.	Name	Age	Relation to Applicant
8.	Name	Age	Relation to Applicant

If children are NOT a part of your household, do any children under the age of 11 ever visit your home regularly (e.g., grandchildren, nephews and nieces), young neighbors). If so, please explain.

Who will have primary responsibility for the care of your pet?

If you answered that a child in the family will have primary responsibility, please list the tasks they will be responsible for like feeding or walking.

Do any members of your household smoke?
If so, do you/they smoke:

Information about your Home

Please describe the type of residence you live in.

Please state how long you have lived at your current residence.

Do you rent, own, or other?

If you rent, does your lease allow pets? How many pets are allowed? Are there any weight restrictions? If you live in a condo governed by an association, what are the rules pertaining to pets?

REQUIRED IF YOU RENT: Name and phone number of landlord/leasing company.

Do you have wall-to-wall carpeting or large area rugs in your home? If yes, please explain what type and in which rooms. (We ask this because some of our dogs are not housetrained or are known to eliminate on carpeted surfaces.)

Do you have a fenced yard? (please answer only if you live in a house or townhouse.)

If you answered that you have a fully-fenced yard, what type of a fence do you have?

If you selected "other," please describe the type of fence you have. Is it dog secure?

Do you have a doggy door?

If you have a pool, is it fenced?

If there is no fence on your property, please explain method of taking/letting your pet out for "potty" breaks.

If you've had dogs in the past, did you use a crate? If so, please explain what you used it for (e.g., house training a puppy, making sure your pet was safe while at work, etc.)

Do you intend to crate your new pet? If so, for how many hours at a time? (We ask this because not all of our dogs are crate trained. We will provide you with details on the dog's crate training history at a later stage in the application process.)

Pet Experience/History

Have you ever had a dog? *

Please list your CURRENT pets:

	Name	Age	Type of Pet	Breed	Weight
1.	Name	Age	Type of Pet	Breed	Weight
2.	Name	Age	Type of Pet	Breed	Weight
3.	Name	Age	Type of Pet	Breed	Weight
4.	Name	Age	Type of Pet	Breed	Weight
5.	Name	Age	Type of Pet	Breed	Weight
6.	Name	Age	Type of Pet	Breed	Weight
7.	Name	Age	Type of Pet	Breed	Weight
8.	Name	Age	Type of Pet	Breed	Weight

Please list any OTHER PETS you have owned in the past that are NOT CURRENTLY WITH YOU:

	Name	Age	Type of pet	What Happened to Pet
1.	Name	Age	Type of pet	What Happened to Pet
2.	Name	Age	Type of pet	What Happened to Pet
3.	Name	Age	Type of pet	What Happened to Pet
4.	Name	Age	Type of pet	What Happened to Pet
5.	Name	Age	Type of pet	What Happened to Pet
6.	Name	Age	Type of pet	What Happened to Pet

Have you ever given away, sold, or surrendered a pet to a shelter or rescue? If so, please describe the circumstances.

What type of food do you/did you feed your pet(s)? Please list name of brand if you used a commercial product.

Schedule

What is your current employment status?*

What is the employment status of your co-applicant?

If you've answered that you or your co-applicant work part-time or work at home all or some of the time, please note that, if you are approved for adoption, we will ask for your employer's name and phone number to verify that information.

How many hours are you (and/or your co-applicant) away from home during an average work day?

How many hours a day during the work day would your dog be left alone?

Where will your pet stay when you are not home?

If you selected "Other", please explain.

How will your dog eliminate ("go potty") when no one is home?

If you selected "Other", please explain.

References (complete ONLY if you currently own a pet or have owned one in the recent past) Enter N/A if you have never owned a dog.

Vet References: Please provide the name and telephone number(s) of your present/past veterinarians, even if you haven't used them in 5 or more years. If you have used multiple vets, please provide contact info for all of them. Please note: You will receive an email from a CHR Representative asking for this information if not supplied. We will not be able to process your application without the practice name. *

Groomer Reference: If you use/have used a groomer, please provide the name and phone number. If you have a dog but do not use a groomer, please explain how you groom your pet.

Dog Walker Reference: If you currently use a dog walker, please provide the name and phone number of that person.

Doggie Daycare or Pet Sitter/Boarding Reference: If you use or have used doggie daycare or a pet sitting service, please provide the name and phone number of that person.

Complete Section Below ONLY If You Have Never Owned A Dog As An Adult

Most of our dogs have hair rather than fur and require grooming (i.e., doggy haircut) every 7-8 weeks. If dog hair is not groomed regularly, painful knots or matting can develop. How much do you estimate a complete groom costs in your area?

Our contract requires that a dog adopted from us be taken to a vet on an annual basis for a checkup, including a heart worm test. How much do you estimate an annual exam with vaccines and heart worm testing costs?

Some of our dogs require special diets due to allergies or other health conditions. How do you feel about having to buy prescription dog food or other types of special dog food if a vet recommends it?

Pet Behavior-- Many of the dogs in our rescue exhibit behavioral problems that can be addressed with proper training. Under each dog's bio, we have included an Ideal Home section that briefly outlines the rescue dog's needs based on their unique behaviors. We urge everyone to review the Ideal Home section of a dog's bio BEFORE applying.

If the dog you applied for has a history of snapping, would you consider adopting the dog if h/she the POTENTIAL to snap at a family member or visitor? A history of snapping will be mentioned in the Ideal Home section of the bio.

Yes, I have experience with a past dog that snapped sometimes.

Yes, I would keep the dog for life, even it means adjustments to my lifestyle to accommodate a dog with special behavioral needs.

No, I do not have the right environment to accommodate or time to train a dog who has the potential to snap at people.

Resource Guarding Behavior

Many dogs come into rescue with a behavioral problem called resource guarding. Dogs will growl while guarding an object they feel is theirs. Dogs may guard food, toys, beds, sofas, and even people. The potential for a dog who resource guards to bite is very strong, esepcially if the owner does adopt careful management strategies to avoid and reduce the behavior. While many dogs with resource guarding issues get better with time or respond well to proper management of the behavior, we cannot guarantee that a rescue dog with a history of resource guarding will eliminate this behavior altogether. CHR will not adopt a dog with serious resource guarding behavior to a family with children under 18 years old age.

Would you consider taking in a dog who resource guards? *

Yes, I would keep the dog for life, even if it means making adjustments to my lifestyle to accommodate a dog with resource guarding behavior.

No, I do not want to adopt a dog with resource guarding issues.

Fearful of Men

We have found that many of our rescue dogs are afraid of men, probably due to the fact that men are usually larger in size and have deeper voices. Behavioral research on fearful dogs suggests that dogs exhibiting fear of men can't control their fear response to men. We understand that it's important to adopters to adopt a dog that will bond with the male in the household as much as with the female. If CHR clearly knows that a dog is fearful of men, we will specify that concern in the Ideal Home section of the dog's bio.

If the dog you are applying for is fearful of men, would that be a concern for you?

Yes, the men in our family play a big role in the caretaking of our dogs and want to enjoy the companionship of a new dog just as much the female(s) of the family.

No, I would keep the dog for life, even if the dog has some type of fear of the men in my household. We understand that a dog’s fear of men may persist for life.

I would like to speak to a CHR behavior counselor to discuss this type of behavior further. My understanding of the problem is not clear enough and a phone consultation is necessary for me to get a better understanding of the dog's needs.

What qualities are you looking for in a dog?

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Is your current pet allowed on the furniture?

If not, how will you train your dog not to jump on your furniture?

What do you consider the MOST ANNOYING habits or behaviors in a dog?

What would have to happen to cause you to return your pet or find your pet a new home?

Some of our rescue dogs have allergies and require a special diet to reduce or eliminate allergic reactions. Would you mind keeping the pet on a special diet such as a raw or prescription diet, or would you rather have a dog that is on a regular diet?

Like people, pets grow old and require non-routine medical care that can be costly. Young pets can also develop serious medical conditions. If you were confronted with major veterinary expenses, what do you consider is the MAXIMUM reasonable amount to spend? (Please be specific)

We take the time to get to know our dogs well to help you find the right fit for your family. Mark ALL the issues that would cause you to NOT ADOPT a certain pet. We do not judge your answers negatively so please don't be afraid to answer honestly.

Not 100% house trained

Pees indoors to "mark" territory

Not being crate-trained or not liking the crate

Dog that is fearful or anxious

Frequent barking

Separation Anxiety

Resource guarding (growling/snapping when a person or dog goes near food or toys)

Limited sight (poor vision or blind in one eye)

Mobility Issues (e.g., dog that can't climb stairs)

Special diet required by vet

Long-term medications

Not getting along with other pets in the home

Aggression towards dogs or humans

Miscellaneous Questions

Have you or someone in your family ever been accused, convicted, or fined for animal-related neglect, abuse, violations, or penalties at your current or previous addresses? (Under Virginia Code Section 3.1-796.96 et seq., we are required to verify this information) *

ADOPTION FEES - Caring Hearts Rescue requests an adoption fee ranging from $375-400. Is this acceptable to you? More information on the veterinary care CHR provides can be found on our website. Due to past issues, CHR does not offer payment plans. *

Additional comments?

How did you hear about us?

Thank you for taking the time to complete this application! If you have any questions or difficulites with this form, please email us at chr-news@caringheartsrescue.org