Canine Castaways Rescue Adoption Application

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

First Name Last Name
Married? *

Yes No
Spouse's Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
Spouse's Phone Number *

Area Code Phone Number
E-mail *
Date of Birth *

Month Day Year
Employer *
Employer Phone Number *

Area Code Phone Number
Job Title *
Spouse's Employer *
Spouse's Employer Phone Number *

Area Code Phone Number
Spouse's Job Title *
Are there any other adults, 18+, living in the home? *

Yes No
Enter names, phone numbers, ages, and relations of other adults living in the home. *
Do you own? Rent? Live with Relatives?
Do you... *

Own your home Rent Live with Relatives
Apartment/Landlord Name *
Landlord Phone Number *

Area Code Phone Number
Please list ages of children in home *
Please list name, breed, and age of current pets you own *
Are your current pets spayed or neutered?
Are your current pets spayed or neutered? *

Yes No N/A
Are your current pets up-to-date on vaccinations AND heartworm preventative?
Are your current pets up-to-date on vaccinations? *

Yes No N/A
Are your current pets up-to-date on heartworm preventative? *

Yes No N/A
Have you had any pets pass away recently? If so, what was the cause? *
Do you have a veterinarian? *

Yes No
Vet's Name *
Vet's Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Vet's Phone Number *

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

Inside Outside Mostly Outside Outside Kennel Garage Tied Out
Is your yard fenced? *

Yes No
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? *

Yes No
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?
Are you financially prepared to deal with the cost of both routine (vaccinations, annual exams, dentals) and emergency care if needed? *

Yes No
References

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

First Name Last Name
Reference 1 - Phone Number *

Area Code Phone Number
Reference 1 - Relationship to adopter *
Reference 2 - Name *

First Name Last Name
Reference 2 - Phone Number *

Area Code Phone Number
Reference 2 - Relationship to adopter *
Reference 3 - Name *

First Name Last Name
Reference 3 - Phone Number *

Area Code Phone Number
Reference 3 - Relationship to adopter *
Any other information you would like to provide us?
Application Fee

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USD Our application fee is non-refundable.
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 Waiver

Canine Castaways Rescue Inc.
In consideration of your acceptance of this adoption form, I for myself, my heirs, executors, administrators and assigns, forever release and discharge any and all rights, demands, claims for damages and causes of suit or actions, known and unknown, that I may have against Canine Castaways Rescue Inc, and any and all participating sponsors and the directors, officers, employees and agents of such parties, for any and all injuries resulting from my visit to Canine Castaways Rescue Inc. I attest and verify that I have full knowledges of the risks that may be involved in visiting Canine Castaways Rescue Inc., and that I assume those expenses.
Date Signed *

Month Day Year
Date
Name *

First Name Last Name
Signature *

Clear
Should be Empty:

Adoption Application

References

Adoption Waiver