Pibbles and Fam Bam Rescue Adoption Form

Pibbles and Fam Bam Rescue Adoption Agreement

ADOPTER 1 *

First Name Last Name

ADOPTER 2

First Name Last Name

Name of Pet You Wish to Adopt *

Email Address (ADOPTER 1) *

Email Address (ADOPTER 2)

example@example.com

Phone Number (ADOPTER 1) *

Area Code Phone Number

Phone Number (ADOPTER 2)

Area Code Phone Number

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Do you own any pets? If yes, how many? *

If you own pets, list type of pet(s) and ages.

Pet Breed(s)

Other pet(s) disposition and behavior towards other dogs?

Please provide your veterinarian's name and phone number:

Do you own or rent your home? *

Own Rent

Do you have a yard? *

Yes No

If "Yes" to the above, is it fenced? please describe

What is your landlord's pet policy? *

If you rent, please provide your landlord's information here (name/number): *

Have you ever surrendered a pet you own to any animal shelter including a "low" or "no kill" shelter? *

Yes No

Are there children in the home? (If yes, please list ages) *

How many hours per day would the pet be alone? *

Will you crate your pet? *

If you have to leave town, emergently or planned, where would your pet stay? *

How would you deal with behavioral issues such as barking, chewing, destructive behavior, bathroom accidents indoors, unruly leash behaviors in your pet? *

Please provide the names, emails, and contact numbers for 3 personal references: *

Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment? *

Yes No

If you answered "Yes" please provide a detailed description:

1| ADOPTER(S) PROMISE TO:

Treat this animal as a beloved member of the family, including providing safe and loving home, a balanced diet, veterinary care, and professional training as necessary;
Keep an ID tag with current address and telephone number fastened to your pet's collar;
Attach a leash to this animal's harness or collar EVERY TIME your pet is out doors and not in a safely enclosed area;
Allow this pet to play or walk off-leash ONLY in a safely enclosed area;
Enroll in behavioral training as needed;and
CONTACT Pibbles and Fam Bam Rescue immediately if your pet become lost/stolen.

2| ADOPTER(S) agree to NEVER:

Abuse or neglect this pet, or allow others to abuse this pet;
Allow this pet to procreate or reproduce;
Place this pet into a shelter, state or county/county/city animal control facility, or with another rescue organization; and
Sell, re-sell, or give this pet away.

3| ADOPTER(S) understand and agree to the following:

Pibbles and Fam Bam Rescue will perform a homecheck and may conduct interviews with personal references, and veterinarian at the discretion of Pibbles and Fam Bam Rescue.
An adoption donation of $______ is required for the adoption of the pet, which covers the necessary pet vaccines and spay/neuter costs. This donation is tax deductible according to IRS 501(c)3 guidelines and non-refundable.
ADOPTER(S) understand that this pet HAS BEEN/HAS NOT BEEN spayed/neutered. If the pet HAS NOT BEEN spayed/neutered, ADOPTER(S) agree to make spay/neuter appointment at Pibbles and Fam Bam Rescue's APPROVED clinic/veterinarian within the timeframe set forth by the ADOPTER(S) preferred veteriniarian.
ADOPTER(S) understand that as of the date of this agreement, Pibbles and Fam Bam Rescue has no further financial or legal liability as it relates in any way to this pet, including but not limited to any damage to person(s) or property, or medical or other expenses.
If ADOPTER(S) no longer want or can no longer care for the adopted pet, ADOPTER(S) will immediately CONTACT Pibbles and Fam Bam Rescue BY EMAIL or PHONE and provide a 30 day period to allow Pibbles and Fam Bam Rescue to make arrangents for the pet to be taken back into rescue.
ADOPTER(S) understand and agree that if at any time Pibbles and Fam Bam Rescue becomes aware of neglect, abuse, or failure, to provide for this pet's care and control, Pibbles and Fam Bam Rescue reserves the right to immediately rescind ADOPTER(S)' adoption of this pet and take this pet back into its care and control without further notice.
ADOPTER(S) agree to indemnify and hold harmless Pibbles and Fam Bam Rescue against any losses, lawsuits, claims, injury, damages incurred by ADOPTER(S) or to any persons or property by adopted pet, once adoption has been completed.
Pibbles and Fam Bam Rescue will disclose any knowledge of the pet's age, breed, physical or mental characteristics, prior experiences, current or future health, and behavior or temperament.
All above information is true and accurate.

Signature of ADOPTER 1 *

Signature of ADOPTER 2 *

Pibbles & Fam Bam Rescue

Email:Pibblesandfambam@gmail.com

Other Email: Info@pibblesandfambam.org

Janine Amity (President) Cell: (623)261-7655

Message Line: (602)753-7889