P.O. Box 7261Fairfax Station, VA 22039-7261hart90office@hart90.org Fax: 703.783.0489
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Roxy
About 10 years Female Dachshund/Pug/Chihuahua Mix
All applications encouraged! HART promotes adoptions that are in the best interest of both the dog and potential adopter. HART does not adopt dogs on a first come first serve basis. All applications will be screened by HART to determine the most suitable match for both you and the animal.
You may submit one application for multiple dogs.
Thank you for your interest in adoption!
Unfortunately our online dog application requires Javascript, which does not appear to be either supported or enabled on your browser. Many features on the HART website require Javascript to be enabled in order to use the full functionality. See your browser's help for information on enabling Javascript.
If you cannot or do not want to enable Javascript, you can still download a copy of our dog application in PDF format to print out and bring to one of our adoption events.
Unfortunately our online dog application does not support your version of Microsoft Internet Explorer. HART recommends updating to the latest version of Internet Explorer or the latest version of Mozilla Firefox.
If you cannot or do not want to upgrade your internet browser, you can still download a copy of our dog application in PDF format to print out and bring to one of our adoption events.
Tell Us About Yourself & Your Home
Your Dog's Enviroment
Find Your Perfect Dog
Previous Pet History
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You are about to remove all of the pet history information from this part of the application. Do you really want to remove it?
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Do you have children?
Names and ages of children:
Do you plan to have children in the future?
Please list members of household, relationship to you, and their ages*:
*Roommate, child, husband, mother, etc.
Do you own or rent your home?
Does lease allow pets?
Do you have a fenced yard?
Type*:
*Chainlink, privacy, etc.
Height:
Are you willing to fence?
Do you have a doggy door?
Do you plan to have a doggy door?
Area around your home:
Type of home:
Length of time living at this location:
List company and length of employment*:
*List for each adult in household
Plans to move or change employment in the near future?
Each day, your HART dog would be left alone?
If you are currently working from home due to COVID-19 restrictions, how will your hours at home change after the COVID-19 restrictions end*?
*Please understand that we have always adopted dogs to people who work outside the home and that has not changed.
When you are not home, your HART dog would be kept?
Please explain:
When you are home, your HART dog would be kept?
On leash, when & where will you exercise the dog:
Off leash, where will the dog be allowed to exercise:
How much time do you realistically have each day to exercise or play with your HART dog?
Each year, you are away from home on vacation/travel?
While on vacation/travel, who will care for your dog?
What do you foresee as normal dog problems?
Have you dealt with behavioral issues with other pets*?
*Housebreaking, chewing, separation anxiety, etc.
How will you encourage/reinforce appropriate behavior?
How will you prevent/manage inappropriate behavior?
Have you ever taken a formal obedience class?
Will you to take your HART dog to obedience training?
If you are not home, will your HART dog be outside unattended?
If you have to move, what will you do with your HART dog?
How long have you looked for a dog?
Why do you want a dog?
Why did you choose Roxy?
Are you interested in other HART dogs?
Names of other HART dogs:
Who will be the primary or sole caretaker of the dog?
What age most appeals to you?
What size dog most appeals to you?
Do you or your home have a weight limit?
Weight limit:
Is your home subject to breed restrictions?
Which breeds are restricted?
What aspects of a dog are most important to you?
What activity level most appeals to you?
What type of coat most appeals to you?
Is someone in your family willing to brush your HART dog often?
How much do you think it will cost to have your HART dog groomed?
$
Is anyone in your family allergic to dander or pet hair?
Where will your HART dog sleep?
How much do you think it costs ANNUALLY to own a dog?
Will you give your HART dog Heartworm Preventative every month?
What causes Heartworm in dogs?
What would cause you to consider giving your dog back to HART? Check any that you think may apply.
Have you owned a dog, cat, or other pet?
You can list up to six (6) pets.
Pet name:
Pet breed:
Gender:
Was pet spayed or neutered?
Where did you get the pet?
Primary vet name & phone:
Number of years with pet:
Current age of pet:
Is pet still with your family?
What happened to the pet*?
*If given up, please give approximate date.
Date and cause of death:
If you have owned more pets than listed here, please inform the HART representative that contacts you.
What heartworm medication have you used in the past?
Have you incurred extraordinary veterinary expenses?
What was the cause of the extraordinary expense?
What was the approximate cost of the treatment?
Have you ever had to give up a pet for any reason?
What happened to the pet?
Will you permit a home visit by a HART Representative?
Do you authorize a vet check by a HART Representative?
How did you hear about HART?
Referred By:
Name:
Address:
City:
State:
ZIP:
Home Phone:
Work Phone:
Cell Phone:
Email Address:
Confirm Email Address:
Please understand that HART promotes adoptions that are in the best interest of both the dog and potential adopter. All applications will be screened by HART to determine the most suitable match for both you and the animal.
HART does not adopt dogs on a first come first serve basis.
After you click "Submit", you will be taken to a confirmation page where you can print a copy of your submitted application. You will also receive an automated email copy of your application. In addition, your application will be forwarded to a HART representative who will contact you within three business days.