Canine Castaways Rescue Adoption Application

Adoption Application
Name and/or breed of animal you wish to adopt*
Adopter's Name*

First NameLast Name
Married?*

YesNo
Spouse's Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Spouse's Phone Number*

Area CodePhone Number
E-mail*
Spouses' Email*
example@example.com
Date of Birth*

MonthDayYear
Employer*
Job Title*
Spouse's Employer*
Spouse's Job Title*
Are there any other adults, 18+, living in the home?*

YesNo
Name of 18+ Adult 1: blanks. Age: blank Phone: Area Code Phone Number
Name of 18+ Adult 2: blanks. Age: blank Phone: Area Code Phone Number
Name of 18+ Adult 3: blanks. Age: blank Phone: Area Code Phone Number
Do you own? Rent? Live with Relatives?
Do you...*

Own your homeRentLive with RelativesOther
Apartment/Landlord Name*
Landlord Phone Number*

Area CodePhone Number
Please list ages of children in home*
Do you currently own any pets?*

YesNoNo, but my roommate/parents/siblings/etc do
Name of Pet 1: blanks . Age of pet 1: blank Dog or cat?Dog Cat Other: Please specify
Name of Pet 2: blanks . Age of pet 2: blank Dog or cat?Dog Cat Other: Please specify
Name of Pet 3: blanks . Age of pet 3: blank Dog or cat?Dog Cat Other: Please specify
Name of Pet 4: blanks . Age of pet 4: blank Dog or cat?Dog Cat Other: Please specify
Are your current pets spayed or neutered?*

YesNoN/A
Are your current pets up-to-date on the following vaccinations?*

Bordetella (dogs)Parvo/Distemper (dogs)Rabies (dogs and cats)N/A
Are your current dogs up-to-date on yearly heartworm testing and preventative?*

YesNoN/A
Have you had any pets pass away recently? If so, what was the cause?*
Do you have a veterinarian?*

YesNo
Vet's Name*
Vet's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Vet's Phone Number*

Area CodePhone Number
Why do you want this pet?*
Where will your new pet be kept? (mulitple answers allowed)*

InsideOutsideMostly OutsideOutside KennelGarageTied Out
Is your yard fenced?*

YesNo
If yes, what type of fence and how tall?*
Have you adopted from us before? If so, when? Where is the pet now?*
Have you given an animal away or taken to animal control?*

YesNo
If Yes, when and why?*
Are you financially prepared to deal with the cost of both routine (vaccinations, annual exams, dentals) and emergency care if needed?*

YesNo
Have you ever been convicted of a felony?*

YesNo
If 'yes', when and for what?
References

Please provide 3 non-family references (vet, clergy, neighbor, co-worker, friend, etc)
Reference 1 - Name*

First NameLast Name
Reference 1 - Phone Number*

Area CodePhone Number
Reference 1 - Relationship to adopter*
Reference 2 - Name*

First NameLast Name
Reference 2 - Phone Number*

Area CodePhone Number
Reference 2 - Relationship to adopter*
Reference 3 - Name*

First NameLast Name
Reference 3 - Phone Number*

Area CodePhone Number
Reference 3 - Relationship to adopter*
Any other information you would like to provide us?
This application is not a binding agreement. Applicant is under no obligation to adopt a dog and Canine Castaways Rescue Inc. is under no obligation to provide a dog to the applicant. Dogs suggested to the applicant based on this application and the subsequent interview and home check may differ from dogs listed on this application, as Canine Castaways Rescue Inc. may believe that different dogs are a better match for said applicant. All applications are subject to acceptance based on a review process that requires collecting information from references and visiting the applicant's home. All decisions on placing dogs in adoptive and foster homes are based solely on the judgment of the volunteers and coordinators of Canine Castaways Rescue Inc. Adoption applications submitted through this form may be denied for various reasons. Canine Castaways Rescue Inc. reserves the right to make all decisions regarding placement or final disposition of any rescued dog in its care whether in, or being placed in, a foster or adoptive home or other facility. By submitting your completed application, you attest that you have read the above disclaimer and agree to the terms therein. Furthermore, you represent that the information you have provided on this form is the truth to the best of your knowledge and belief. I hereby forever release, discharge and agree to hold harmless and indemnify Canine Castaways Rescue Inc., its board of directors, and its members, Officers and agents from all claims, demands, actions, causes of action or liability of any kind whatsoever arising as a result of or in connection with the fostering or adoption of a dog sponsored by this organization.

Adoption Application

References

Adoption Waiver