AdoptionForm

Filling out this application to adopt an animal from H.E.A.L., Inc, does not guarantee approval. We reserve the right to reject an application based on the information obtained on this application, through a reference check, or home visit check. Our primary goal is for the welfare, health, and safety of our companion animals who we have rescued. These animals are part of our family and it is our intention to ensure that they have the best care and are loved for the remainder of their natural lives.

H.E.AL, Inc. requires a $25.00 non-refundable application fee. Application fee may be paid via Paypal (https://www.paypal.com/) ; please select “Gift” so no Paypal fees are charged) or a check or money order may be mailed to either of the addresses below along with your complete application. Our PayPal address is helpingeveryanimallive@gmail.com

Michele Castillo: 200 Vandergrift Drive Jacksonville, NC 28540

*Please note: Applicants must be at least 21 years of age.

Applicant's name: *

Physical Address: *

Mailing address (if different from above)

E-mail Address: *

Home Phone Number: *

Cell Phone:

Work Phone:

Preferred Phone Number for contacting you: *

Best Time to Call: *

Employer: *

Employer's Phone Number: *

Animal Name/ ID Number: *

Breed: *

Color/ Markings: *

Gender: *

Approximate Age: *

ATTENTION RENTERS: A copy of your landlord's complete pet policy including specification of any breed or weight restrictions if present, must be attached. H.E.A.L, Inc. is not responsible for any additional monthly pet fees required by your lease agreement or pet policy. Application will not be processed without this documentation.

Please list all persons living in your household (name, age, sex, relationship to Applicant): *

Do you own or rent your home?: *

If you rent, do you have your landlord's permission to keep a rescued animal?:

Landlord's Name:

Landlord's Phone:

How many pets are allowed according to your rental agreement?:

Attach pet policy if you are renting:

Approximate size of your yard: *

Type of fence: *

Height of fence: *

If no fence, describe how you will exercise the animal safely: *

Does your city or county have a limit of pets per household?: Yes
No
*

If yes, what is the limit?:

What is the number of your Local Animal Control: *

Is anyone in your household allergic to dogs or cats?: Yes
No
*

Please specify which animal the person or persons is allergic to in your household:

Do all members of your household agree to have a rescue animal in your home?: Yes
No
*

Please list all household pets that have resided in your home in the last 5 years: (list the type of breed, gender, age, if they where spayed/or neutered, up to date on all their vaccinations, on monthly HW, Flea/tick Preventatives, and tell us where your pet is now (please explain in detail)

Vet's full address: *

Personal reference 1- full name: *

Phone Number: *

How does this person know you?: *

Personal reference 2- full name: *

Phone Number: *

How does this person know you?: *

Personal reference 3- full name: *

Phone Number: *

How does this person know you?: *

Please provide up to 3 references of people with whom you have worked in rescue, if available. This may include shelters, other rescue, or animal transporters. Not having references of this nature will NOT disqualify you as an adopter with H.E.A.L, Inc.

Rescue reference 1- full name:

Phone Number:

How does this person know you?

Rescue reference 2- full name:

Phone Number:

How does this person know you?

Rescue reference 3- full name:

Phone Number:

How does this person know you?

Please provide any other information you feel would help us evaluate your application:

Filling out this application to adopt an animal from H.E.A.L, Inc, does not guarantee approval. We reserve the right to reject an application based on the information obtained on this application, through a reference check, or home visit check. Our primary goal is for the welfare, health, and safety of our compassion animals who we have rescued. These animals are part of our family and it is our intention to ensure that they have the best care and are loved for the remainder of their natural lives.

RELEASE OF LIABILITY AND INDEMNIFICATION

The adopter understands that all work done with H.E.A.L, Inc. and/or its rescue animals is at his/her own risk, and hereby releases H.E.A.L, Inc., its officers, volunteers, agents, employees, contractors, and representatives, from any liability of any kind whatsoever arising from his/her voluntary adoption of any animal from H.E.A.L, Inc. and/or from any claims relating to adoption, ownership or possession of the animal. The adopter also agrees to indemnify and hold harmless adopting agent, its officers, volunteers, agents, employees, contractors, and representatives from any and all losses, fines, claims or damages, including reasonable attorney's fees, arising out of our relating to the animal or his/her voluntary adoption of said animal, including any claims for injury or damage to persons or property caused by the animal.

The undersigned application has been advised of these facts, has read and understands all content of this application, and agrees to all conditions herein. Applicant certifies that he/she is above the age of 21 years old and all of the above information given is true and complete. Applicant agrees to follow all the Rules and Procedures of H.E.A.L, Inc. H.E.A.L, Inc. reserves the right to refuse any applicant without explanation.

Date: *

Signature: *

Full Name:

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