ME or anyone...

[Romanwild]

I need a adoption form to use tonight.

I lost the one that ME gave me.

[msvette2u]

http://www.hscipets.org/adoptapd.htm

My other computer is "down" momentarily and I can't get our own form for you.
I'll try to find it online but here's this just in case

[msvette2u]

Name of Dog I am interested in adopting: _______________________________


Name(s): ____________________________ Date: ________________

Address: _________________ City: _____________ State: _____ Zip: _______

Phone: ________________ E-Mail:____________________ Age: ________

What kind of pets have you had in the past? __________________________

Current pets in the home _________________________________________

Are your pets currently altered and current on their shots? _____________

What happened to the pets you no longer have? _______________________

______________________________________________________________


Why do you want to adopt this pet? _________________________________

______________________________________________________________

How many people are in the home? ________ Ages: _____________________

Does any one living in the home have allergies to pets? __________

How many hours a day will this pet be left alone?

Explain: ________________________________________________________

_______________________________________________________________

What type of home do you live in? ____________________________________

Landlord Phone Number: _______________________________

What type of fence do you have? ____________________________________

If your dog is not house trained how will you do it? _________________________________________________


Who is your veterinarian? _____________________Phone#________________

Will you be able and willing to exercise this pet? ________

Method: __________________________________________________________

Where will this pet be during the day? ________________________________

Night: ____________________________

Are you willing and able to take care of this pet for its natural lifetime? ________

If you are unable to do so, what will you do? __________________________

________________________________________________________________

Do you plan on moving in the near future? ____________

Occupation: ____________________How long at your current job? _________

Have you ever given a dog to a shelter/humane society? _______________

Reason for giving the pet away?

________________________________________________________________

If you own your home can you provide a tax statement, mortgage statement, etc, as proof? __________




List two non-relatives who can verify that you are a responsible, caring person:

Name: __________________________ Phone: _____________________

Name: __________________________ Phone: _____________________




Do you have any experience with this breed of dog? Explain _______________



_________________________________________________________________

Do you agree to enroll this pet in obedience training to begin within 2 weeks of the adoption date and provide said proof to Small Time & DDW Rescue?
__________


I certify that the above information is true and accurate to the best of my knowledge and that I understand that falsification of information can be cause for denial of my application or future forfeiture of the adopted pet.

Date: ______________

Signature of applicant(s):_______________________ ________________________

[msvette2u]

Agreement too:

Pet Adoption Agreement

Pet’s Name: ________________ Description: __________________

Sex: ____ Age: _________ Altered:______

Date to be altered ____________

Adopter’s Name(s): _____________________________________

Address: _____________________________________________

City: _________________________________________________

State: _____________ Zip: __________

Home Phone: _______________________

Work Phone: ________________________

As the adopting party, I/We agree to the following provisions: (initial each)

_____1. I/We agree to keep said pet licensed in my county. I understand that by keeping tags on my pet that it will insure my pet a safe return if he happens to get lost. I will contact Kaye Smith or Christa Medders if my animal becomes lost.

_____2. I/We agree to keep my pet up to date on his shots, as prescribed by my vet. I will provide immediate medical care if my pet becomes injured or sick.

_____3. I/We agree to keep the animal I am adopting as a house pet. I will provide proper shelter in the heat and cold, if the pet is outside for any length of time.

_____4. I/We agree not to let my adopted pet run at large, or become a nuisance.

_____5. I/We agree not to abuse or neglect the adopted animal, and I authorize Kaye Smith or Christa Medders, at her sole discretion, to determine whether of not the pet has been abused or neglected.

_____6. I/We understand that Kaye Smith or Christa Medders cannot guarantee the health, temperament or training of the above described animal, and hereby release Kaye Smith and Christa Medders from any claim, cause of action or liability for any Injury or damage to persons or property once the animal is in my possession. If a health problem develops I will notify Kaye Smith or Christa Medders to discuss the matter.

_____7. I/We agree that if Kaye Smith or Christa Medders should determine at any time that any of the provisions of this agreement are not being complied with, I will return the pet to Kaye Smith or Christa Medders upon demand.

_____ 8. I/We agree that Kaye Smith, Christa Medders and Small Time Dog Rescue/Dead Dog Walking Pit Bull Rescue are not responsible legally, medically or in any way for any harm that may happen to or be caused by the pet I am adopting. This includes harm caused by or to visitors/relatives in my home.

_____9. I/We agree that said dog will not be used for any illegal purposes and will NEVER be fought in any way. If this clause is broken, I/We understand that the dog will be immediately confiscated by Kaye Smith, Barry Springer and/or Christa Medders and all law enforcement agencies will be notified, as applicable.

_____10. I/We certify that we do not live in an area where "Pit Bulls" are banned.

_____11. I/We have enrolled this pet for obedience training at _______________________________

which will be started on the following date: _________________________

Animal Return: I understand that if I am not able to keep the pet for its natural lifetime, I will contact ___ or ____. Kaye Smith and Christa Medders have first right of refusal. I will not give the adopted pet away without first contacting Kaye Smith or Christa Medders. I will not euthanize the pet without first contacting Kaye Smith or Christa Medders.

There are No refunds.

Signature of adopter(s): __________________________ _________________________


Date: ____________ Donation: $_________

[Maryellen]

did i post one in rescue the contract?

[Maryellen]

PROSPECTIVE HOME APPLICATION

Today’s Date: ___________________

First Name: _______________ Middle Initial:_____

Last Name:______________________

Spouse/Partners’ Name: ____________________________________

Address:____________________________

City:_______________________________ State:______

How long at your present address: ____________

Do you plan on moving? ______________________

Home Phone Number:_______________________

Employer: ________________________________________________

Your Occupation: ____________________________

Spouses/Partners’ Occupation: _________________________________

Work Phone Number:_______________________

Spouse/Partners’ work phone number: _____________________________

Driver’s License Number & State Issued: _________________________

Best time to call: __________________________

Valid Email Address: ______________________

Age:_____

Do you agree to absolve _____________ and all of its representatives from any liability in reference to any adoptive dog?
Yes _____ No _____

Do you agree that the dog is to be kept as a house pet; That it shall not be used for medical or any other experimental purpose?
Yes No


Dogs Living Situation: (check all that apply)
____Dog will be a house pet, living inside with the family
____Dog will live in basement or garage
____Dog will live outdoors
____Doghouse provided
____Guard Dog for Business____ or Residence____
____Other: please specify____________

How will you exercise the dog? (check all that apply)

____Leash walk everyday
____Will have cable in the yard
____Will be free to run in fenced yard
____Will be free to roam around (off leash and unsupervised in an unfenced area)
____Will bring to Dog Park (Enclosed area where all dogs are allowed to run and play together off leash)
____Other: please specify____________________

How many hours will dog be home alone each day? _______________
Where will dog be kept when home alone? __________ In crate? ____

Yard size is: small_____ medium _____ large ______ multiple acreage____
No yard______
Is the yard enclosed by a fence? Yes_______ No ______
Height, length and type of fence: _______________________________

Please check whether the home is a house _____ or an apartment _____
Do you own the property? Yes_____ No ______

If you are renting please provide Landlord’s name and phone number for verification: ________________________________________________


Please check whether the home is in an:
Urban ____Suburban____ Rural ____ Setting.

Does your municipality have any breed restrictions? Yes ____ No ____
Not Sure _____
If so, please describe the nature of the breed restrictions: __________________________________________________________________________________________________________________________

How many adults (21 and older) in your household? ____
How many individuals under 21 in your household? ____
Any children? Yes ____ No ______ If yes, please list ages: _____________
Do you have other dogs? (Check all that apply)
____No other dogs
____One or more spayed females
____One or more neutered males
____One or more unspayed females
____One or more unneutered males

Please specify breeds and ages of other dogs: _____________________________________________________________

If you had other dogs in the past, please let us know what happened to them: (check all that apply)
____Still have the dog(s)
____Died of old age or fatal disease
____Was hit by a car
____Was stolen
____Lost
____Gave or sold to friends, relatives or acquaintances

What other kinds of animals do you own? ___________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________



Please list any other prior experiences you have had with the breed of the dog you are interested in adopting:
__________________________________________________________________________________________________________________________

Are you familiar with Canine Heartworm and how to prevent it? Yes No

What method of housebreaking will you use (if not already trained)
_____________________________________________________________

Are you familiar with crate training? Yes No

Please supply the name and phone number of your current/previous veterinarian: _____________________________________________________________


Please give three references not related to you. For example, your employer, clergyman, etc. who can attest to your character:

1. _________________________________ Phone # ___________________

2. _________________________________ Phone # ___________________

3. _________________________________ Phone # ___________________

The above questions have been answered truthfully and to the best of my knowledge. Any fraudulent information intended to mislead _______________ will result in termination of any animal adoption. __________________ reserves the right to revoke applications at their discretion. Thank you.

Signature __________________________ Date ______________________