Rescue Application to Adopt

Application to Adopt
Fee includes transportation to a predetermined designated meeting place, a health certificate, spay/neuter, all current vaccinations, 30 Days of Free Pet insurance, a microchip with lifetime registration and an Adoption Starter Kit.

Once we receive the completed application we can have a volunteer process it and get back to you. Please keep in mind any breed descriptions are just based on appearance and our dogs have not been given a DNA test to confirm any breed specification.

Due to the increased interest in our available dogs and limited volunteers, volunteers are not able to call individuals expressing interest unless an application to adopt has been filled out prior.

Your Contact Information
Full Name *

First Name Last Name
Phone Number *

- Area Code Phone Number
E-mail *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Are you over 18 years old? *

Yes No
Parent or Legal Guardian

First Name Last Name
Phone Number

- Area Code Phone Number
Do you currently have applications with other rescues for dogs ? *

Personal References
Please list at least one non relative reference.
Full Name *

First Name Last Name
Phone Number *

- Area Code Phone Number
Relationship *
Full Name *

First Name Last Name
Phone Number *

- Area Code Phone Number
Relationship *

Veterinarian Reference
Do you have a current Veterinarian? *
Please submit a Professional Reference in lue of a Veterinarian Reference. You can also use this to add a second veterinarian if you use more the one or have a veterinarian reference from past pets.
Professional Reference

First Name Last Name
Phone Number

- Area Code Phone Number
Professional Reference Relationship *
Please contact your Veterinarian Clinic to give consent for a volunteer to speak with them.
Clinic Name *
Veterinarian's Name: *
Phone Number *

- Area Code Phone Number

Household Information
How many adults live in your home? *
Do you have children at home? *
How old are they?
Does everyone in your home agree to adopting a dog? *
How long have you lived at your current residence? : *
Do you own or rent your home? *
Landlords Full Name

First Name Last Name
Landlords Phone Number *

- Area Code Phone Number
Does the landlord permit a pet of this size? *
Please Explain.
Do you have a fenced in yard? *
What kind of fence, and how high? *
How do you plan to exercise the dog? *
Do any pets currently live in your home?
Please list all pets that currently live in your home: *
Please list pets you no longer have if any from the past 5 years with reason as to why you don't have them any more.
ie - died due to old age, re homed because..., illness, etc
Are all of your current pets vaccinated? *
Are all of your current pets spayed/ neutered ? *
How many hours a day will this dog be left alone? *
When you are gone where will the dog be kept? *
Where will the dog sleep at night? *
Are you willing to attend dog obedience courses if needed? *
What dog are you interested in adopting? *
If no specific dog is selected please list what age, sex, and breed you are interested in. *

Terms and Conditions
Please read and sign all statements below:

TIP: Draw your signature in the signature field (left click, hold and draw)
I hereby certify that all provided information is complete and true to the best of my knowledge. *

Clear
On this date: *

- Month - Day Year
I understand that a Rescue member may conduct an interview and home check. *

Clear
On this date: *

- Month - Day Year
I understand I must spay/neuter the dog within 90 days of adoption. *

Clear
Type a question
On this date: *

- Month - Day Year
If proof of spay/neuter is not furnished to Rescue within 90 days of adoption I will be contacted by Rescue. *

Clear
On this date: *

- Month - Day Year
I understand that failing to spay/neuter the dog is a violation of this contract and will result in legal action. *

Clear
On this date: *

- Month - Day Year

BUYER’S INSPECTION AND REFUND
BUYER’S INSPECTION AND REFUND"UNDER STATE LAW YOU HAVE THE RIGHT TO INSPECT THE OFFICIAL HEALTH CERTIFICATE CONTAINING A DESCRIPTION AND MEDICAL HISTORY OF ANY DOG OR CAT OFFERED FOR SALE AND TO HAVE A COPY OF SUCH CERTIFICATE FOR ANY ANIMAL YOU MAY PURCHASE.

"437:13 Examination by Licensed Veterinarian. – Within 14 days of transfer, the dog from a licensee may have the dog examined by a licensed veterinarian selected by the transferee and, unless said examination indicates the dog to be free of disease, the transferee shall be entitled to substitution or, at the transferee's option, a full refund of the purchase price of the dog, if applicable, upon return of the dog, to the licensee within 2 business days of said examination, accompanied by the veterinarian's certificate.

Please read and electronically sign the statements below.
If you choose to keep the dog, Rescue WILL NOT be responsible for any fees incurred by the adopter due to illness or injury of the dog. *

Clear
On this date: *

- Month - Day Year
You the adopter will only be eligible for a limited refund of the full adoption fee if you choose to return the dog to Rescue with a licensed veterinarian's certificate of proof stating the dog's health issues and conditions. *

Clear
On this date: *

- Month - Day Year
Rescue will not be held liable for any fees associated with the dog's expenses during the time you the adopter had ownership of the dog. Examples of expenses are but not limited to veterinarian's appointments, medications, food, and so on. *

Clear
On this date: *

- Month - Day Year

ADOPTION FEES: RETURNS/ REFUNDS:
I understand that if I cannot keep the dog I adopt from Rescue, that I will return this dog to Rescue, and not another person or shelter. *

Clear
On this date: *

- Month - Day Year
I understand that depending on the return reason and time elapsed after adoption a refund may not be possible. *

Clear
On this date: *

- Month - Day Year
I acknowledge that there is a non-refundable $50 deposit on most dogs. *

Clear
On this date: *

- Month - Day Year
Electronically signing below implies you have read and are agreeing to the terms stated above. You are also verifying all information provided is true to the best of your knowledge: *

Clear
On this date: *

- Month - Day Year
PLEASE NOTE: The Board of Directors reserves the right to modify any regulation provided it does not conflict with any state regulations.By electronically signing your name on the line below you certify that you have read and agreed to all terms listed above. *

Clear
On this date *

- Month - Day Year

Rescue LIABILITY RELEASE AND WAIVER FORM:
I hereby, for myself, my heirs and my personal representatives, represent and warrant as follows:
I am fully aware of the risks that dogs pose and have elected to view and/or interact with one or more dogs in the care of Rescue voluntarily. I knowingly assume all risks that exposure to dogs may pose, including but not limited to, serious bodily injury and/or death. *

Clear
On this date *

- Month - Day Year
I hereby waive, release, discharge, hold harmless, and promise to indemnify and not to bring suit against Rescue, its directors, officers, volunteers, staff, and all other agents, and attorneys for any of the referenced parties, and any other parties action for, or on behalf of any of the referenced parties from any and all rights and claims which I have or which may hereafter accrue to me and from any and all damages which may be sustained by me directly or indirectly in connection with, or arising out of, my exposure to such dogs. *

Clear
On this date *

- Month - Day Year
Yes, I accept this waiver and release from Rescue all liability. *

Clear
On this date *

- Month - Day Year
By electronically signing your name below implies you are agreeing to the terms stated above and certifies that you have read and agreed to all terms listed above: *

Clear
On this date *

- Month - Day Year
Should be Empty: