Xtreme Rescue Inc Application

Xtreme Rescue Inc Application
What are you interested in?*
Pet Name*
Type 'general enquiry' if you are not enquiring about a specific pet
Personal Information:
If you do not know what you are looking for, would you be interested in fostering or adopting a senior or special needs dog?*
Full Name*

First NameMiddle NameLast Name
DOB*
***MUST BE AT LEAST 25 YEARS OLD***
Occupation*
Please spell out Company’s Name. If you work from home please let us know!
Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Home Number
Doesn’t apply if you don’t have one
E-mail Address*
Best time to reach you at:*
Residency Information:
Do you own or rent your home?*
How long have you lived at this address?*
Please include how many months/years.
If you have marked own, will the home ownership be under your name? If not, why?*
Type of Home*

HouseVilla/TownhouseCondo/ApartmentOther
Personal Reference:*
Full Name & Phone Number
Professional Reference:*
Full Name & Phone Number
How many people live with you?*
Who lives with you in your household?*

Boyfriend/GirlfriendHusband/WifeFather/MotherBrother/SisterChild/ChildrenOther
Number of children living in household:
Age of children living in household:
Have the children had previous pets?
Does not apply if you don’t have any.
Is anyone in the household allergic to pets?*
Do you have a pool?*
Is your yard fenced?*
Height of fence:*

4ft6ft8ftOther
Type of fence:*
Do you have a doggie door?*
Why would you like to foster/adopt from us? (Check all that apply)

Companion for selfCompanion for another petCompanion for childOther
Pet Information:
Is this your first dog?*
Do you currently have any pets?*
Do you have past ownership experience with the breed of dog that you are inquiring about?*
What breeds do you have past ownership experience with?*
If you currently have other pets please let us know about each of them (name, species, breed, age, sex, etc)*
Do you keep them up to date on vaccinations?*

YesNo
Are they spayed/neutered?*

YesNo
Are they on monthly preventatives against heartworms, fleas, ticks, etc.?*

YesNo
If you have said "No" to any of the above questions please explain:
Have you ever relinquished a pet to a shelter or given them away? If yes, please explain why:*
Have you ever had a pet euthanized? If yes, please explain why:*
How many hours per day will the dog be alone?*
Where will the pet stay when no one is home?*
Specify if the dog will be crated, have free range or be cared for by a friend/family member or at a doggie day care.
Where will the pet stay when the family is out of town?*
Specify if the dog will be joining you, cared for by a friend/family member or at a pet resort.
What is your hurricane evacuation plan?*
Would you ever give up your pet? If so, why?*
Veterinarian's Contact Information:
Name of Hospital & City/State:*
Name of Veterinarian:
If your pets see a specific one then please name them.
Phone Number:*
Before submitting your inquiry, please check all boxes to acknowledge that you have considered the following in regards to adopting a pet: (Does NOT apply to those interested in fostering)*

Daily care for a pet - food, bedding, toys, etc.The cost of ongoing flea, tick, heartworm, deworming treatments, vaccinations, etc.If you are prepared to/can afford any necessary training/emergency vet bills
Adoption Fees:

(Does NOT apply to those interested in fostering)
Our adoption fees sometimes vary depending on the dog you are interested in.

•Dogs/Puppies between 8 weeks and 7 years old are $300.

•Senior Dogs over the age of 7 years are $150.

•If the dog has medical issues that required daily medications or is simply special needs the adoption fee is $150.

*Our adoption fees are non refundable as we put the money towards the dogs we currently have in hospice/terminal care and that have medical.
Are you able to afford our adoption fee for the dog you are inquiring about?*
Please read the following carefully:
I certify that the above information is true and correct to the best of my knowledge. I also acknowledge that falsification of the above questions can lead to my application being denied and that I MUST keep all contact information up to date with Xtreme Rescue Inc.
Signature

Clear
In the event that I no longer can properly care, maintain and/or want this dog; I hereby clarify that I will promptly return he/she back to Xtreme Rescue Inc. By signing this, I also am aware that if the rescue feels the need to take the pet back from me or conduct a welfare check that I must cooperate with a representative from the rescue and allow them to do their duties.

I also am aware that if I want to adopt a stray dog that is currently under Xtreme Rescue Inc. and came off the streets of Miami-Dade County or any other county that does not have a public stray hold, that I cannot legally claim or alter the dog/cat in any way until the 90 day stray hold is up from what Florida Statute, Chapter 705 on Lost or Abandoned Property states. The adoption will then be finilized by Xreme Rescue Inc. In the case that the dog's true & rightful owners do show up with valid proof of ownership, I know that I must return the dog back to Xtreme Rescue Inc. who will release the animal back into the owner's custody.
Signature

Clear
By submitting this form, you acknowledge that you understand that completion of this appliaction does not guarentee adoption approval for our pets. Our adoption coordinator will contact you within 7-10 business days if you application is approved. Please go back and answer any blanks you have missed or skipped.
Should be Empty:

Xtreme Rescue Inc Application

Personal Information:

Residency Information:

Pet Information:

Veterinarian's Contact Information:

Adoption Fees: