Rescue Application to Adopt

Our adoption fee is $300 -$400 and includes transportation to a predetermined designated meeting place, a health certificate, spay/neuter, all current vaccinations, 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.

Full Name *

First Name Last Name

E-mail *

Phone Number *

- Area Code Phone Number

Address *

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

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 *

Clinic Name *

Veterinarian's Name: *

Phone Number *

- Area Code Phone Number

How many adults live in your home? *

Do you have children at home? *

If yes 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? *

If your rent please fill out the following questions regarding your landlord:

Full Name *

First Name Last Name

Phone Number *

- Area Code Phone Number

Does the landlord permit a pet of this size? *

All applicants please fill out the following:

Do you have a fenced in yard? *

If so what kind of fence, and how high? *

How do you plan to exercise the dog? *

Please list all pets that currently live in your home: *

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. *

I hereby certify that all provided information is complete and true to the best of my knowledge.

Electronically signed by: *

First Name Last Name

On this date: *

- Month - Day Year

I understand that a Rescue member may conduct an interview and home check.

Electronically signed by: *

First Name Last Name

On this date: *

- Month - Day Year

I understand I must spay/neuter the dog within 90 days of adoption.

Electronically signed by: *

First Name Last Name

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.

Electronically signed by: *

First Name Last Name

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.

Electronically signed by: *

First Name Last Name

On this date: *

- Month - Day Year

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.

Electronically signed by: *

First Name Last Name

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.

Electronically signed by: *

First Name Last Name

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.

Electronically signed by: *

First Name Last Name

On this date: *

- Month - Day Year

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.

Electronically signed by: *

First Name Last Name

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.

Electronically signed by: *

First Name Last Name

On this date: *

- Month - Day Year

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

Electronically signed by: *

First Name Last Name

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:

Electronically signed by: *

First Name Last Name

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.

Electronically signed by: *

First Name Last Name

On this date *

- Month - Day Year

I authorize I have read and agreed to the terms listed above in the Buyers and Inspection Refund agreement.

Electronically signed by: *

First Name Last Name

On this date *

- Month - Day Year

I hereby, for myself, my heirs and my personal representatives, represent and warrant as follows:

1.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.

Electronically signed by: *

First Name Last Name

On this date *

- Month - Day Year

2.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.

Electronically signed by: *

First Name Last Name

On this date *

- Month - Day Year

Yes, I accept this waiver and release from Rescue all liability.

Electronically signed by: *

First Name Last Name

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:

On this date *

- Month - Day Year

Electronically signed by: *

First Name Last Name

Application to Adopt

Your Contact Information

Personal References

Veterinarian Reference

Additional Information

Please read and initial all statements below:

BUYER’S INSPECTION AND REFUND

ADOPTION FEES: RETURNS/ REFUNDS:

Rescue LIABILITY RELEASE AND WAIVER FORM: