Your Full Name Email Address Address Line 2 Town County Eircode Phone Number Minimum Age I confirm I am 21 or older Name of dog you are interested in: Are you the lead of the household in which you live? Yes No If NO, is the lead of the household happy to sign adoption papers and take legal responsibility for the animal? Yes No Your Accommodation Home Owner Renting (Private) Renting (Council) Renting (Housing Association) If renting how long you lived at this address & do you have permission from your landlord to have a dog? Do you plan on moving at any time? Yes No Do you have a secure rear garden? Yes No If No, please describe Do you have children, what age? 1-5 6-12 Teenagers None Is everyone in your household in agreement to adopting? Yes No How many people live in your home? Is there anyone in the family that suffers from allergies or asthma? Do you already have animals? None Dogs Cats Others If you currently have no animals, have you ever had pets before? * Yes No If Yes, tell us briefly about them Where will the dog sleep? Where will the dog be when left when unattended? Tell us about your animals briefly eg male/female, age, neutered, temperament etc Are you looking for a male or female pet? What age pet would you prefer? What qualities do you prefer in a pet? Would you like a pet that is: Good with children Good with cats Good in the car Low energy Medium energy High energy House trained What are your working arrangements? Is someone home for the majority of the day? What is the longest block period of time the dog would be left unattended? Have you got holidays booked over the next six months? Have you had a home visit from another rescue team in the last 12 months? Yes No If so, what was the outcome? Are you in agreement to a home visit/video call by H.A.R.T? Yes No If there is any further information you would like to provide us with regards to your situation please provide it below. Adoption Fee I understand there is an Adoption Fee payable at the start of the trial which will be refunded if the trial does not work out. Personal Information I agree that H.A.R.T. can share my information with it's team of volunteers Send
