Bobbie’s Heart

P.O. Box 368

Rosepine, LA 70659
Bobbiesheart18@yahoo.com
337-718-8288

CONTACT Greg Menkins – President Deridder, Jimmie D Menkins – V. President Deridder, 318-718-8288,
BobbiesHeart18@yahoo.com

Bobbie’s Heart Rescue: Form APPLICANTS MUST BE 21 YEARS

OF AGE. All current dogs in the house must be spayed or neutered. Must have identification
showing current address Must have the knowledge and consent from landlord. Be able and
willing to spend the time and money necessary to provide training, medical treatment (which
includes monthly heartworm prevention) and proper care for the pet. Completion of this
application does not guarantee adoption of a BHR dog/dogs.

1.Name: __________________________________________________________
2.Address: ________________________________________________________
3.Phone: _____________________________
4.Date of Birth: _________________________
5.Name of dog you’re interested in adopting: ________________________________
6.Is this your first dog? ____________________________
7.What kind of pets have you had in the past? What pets do
you have now?
__________________________________________________________________________
8. Are they spayed/neutered? ____________________________
9. Are they currently vaccinated? ___________________________
10. Are they on heart-worm prevention? If yes, what kind? How often?
__________________________________________________________________________
11. Have you ever turned your dog into a shelter? If yes, explain.
__________________________________________________________________________
__________________________________________________________________________
12. Have you ever euthanized a pet? If yes, Explain.
__________________________________________________________________________
13. Are your current pets/ past pets obedience trained? ___________________________
14. Why do you want a dog?
____________________________________________________
15. How many adults in your home? _____________________________________
16. How many children? Ages?
__________________________________________________________________________
17. Is someone responsible at home during the day? If yes, who?
__________________________________________________________________________
18. How many hours a day would the dog be alone? Why?
__________________________________________________________________________
19. Do you own your home?
______________________________________________________
20. If you rent, may we contact the owner? If yes, please include name and number.
___________________________________________________________________
21. Do you have a fenced in yard with a gate?
_______________________________________
22. If no, are you willing to take the dog for walks each day?
__________________________
23. Do you have a doggy door? ______________________________
24. Will there be times when the dog will be tied up? If yes,
explain.____________________________________________________________________
__________________________________________________________________________
25. Do you have a pool? If so, is there a fence around it? _____________________________
26. If the dog is not housebroken, what method will you use to train it?
________________________________________________________________________

27. Who is your veterinarian? Please provide name and number.

__________________________________________________________________________

28. Do you plan to keep the dog up to date on vaccinations and Heart-worm prevention?
_______________________
29. Where will the dog be kept during the day?
__________________________________________________________________________
30. Where will the dog be kept at night?
____________________________________________________________________
31. If you go away for a few days, who would care for the dog?
__________________________________________________________________________
32. If you move, will you take the dog with you? If no, please explain.
___________________________________________________________________
33. Are you willing to care for the dog for the next 10 to 15 years? _____________________
34. Are you willing to allow a BHR representative to come see where the dog will be living?
______________________________________________
35. Do you agree to return the pet if the adoption does not work out for either you or the
dog? _____________________________________
 36. Is there anything else you would like BHR to know?
_____________________________________________________________________
It is agreed, by the signed, herein after referred to as the “responsible party” that the
responsible party accepts full responsibility for any legal liabilities, medical test, or
vaccinations required by law as a result of any animal from the Bobbie’s Heart Rescue. It
also agreed that the dog will be returned to BHR in the event the responsible party can no
longer keep the dog.

Responsible Party Printed Name: _________________________

Responsible Party Signature: _________________________
Date: _________