Ani's Orphans, Inc. Adoption Application

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Phone Number

Area CodePhone Number

YesNo

Message and data rates may apply. Message frequency varies depending on activity.

We will never share your email address or phone number.

YesNo

2. Who are you interested in learning about/meeting?

YesNo

If yes, please describe

4. On average, how many days per month are you out of town (business and/or pleasure)?

5. How would you describe your home environment/lifestyle?

6. List all residents of the household, including their ages and relationships to you

YesNo

10. Please describe activities of a typical weekday and a typical weekend (family activities, time spent in and out of the house, and anticipated amount of time the dog will be spent alone)

YesNo

12. If yes, please list pets in the home, whether they're spayed and neutered, up to date on vaccines and prevention.

YesNo

If yes, please explain.

YesNo

20. If no fence, how will you keep your dog in the yard?

21. Who will supervise all the dog's outdoor activities?

22. What behavioral or training issues are you comfortable with (e.g., fearfulness, leash pulling, discomfort with other dogs/people/cats, chasing animals/people, separation anxiety)?

23. What behavioral or training issues are you uncomfortable with (e.g., fearfulness, leash pulling. discomfort with other dogs/people/cats. chasing animals/people, separation anxiety)?

24. What circumstances would cause you to return an animal to us?

YesNo

26. If so, please explain the situation and the steps taken that led to the decision to surrender the animal.

YesNo

If yes, please describe your experience with the organization and the dog

28. Please provide the names, phone numbers, and email addresses of three references (no direct family members) and the veterinarian you currently go to or plan to go to

YesNo

Applicant hereby indemnifies, releases, and holds harmless Ani's Orphans, Inc., its officers, directors, employees, invitees, contractors, agents, and assigns (each an "Ani's Party" and collectively, the "Ani's Parties") from and against any and all losses, damages, expenses, liabilities, suits, claims, actions, demands, complaints, and liabilities of any kind or nature which Applicant may have or hereinafter may have against any of the Ani's Parties, and in any way related to, or arising from, directly or indirectly: (A) the actions contemplated by this Application; (B) the interaction with animals by Applicant; or (C) the acts or omissions of Applicant in connection with the activities contemplated by this Application. Applicant's duty to indemnify, release, and hold harmless hereunder includes, but is not limited to, claims related to or arising from bodily injury or death, damage to property and the loss of use of property resulting from such damage, regardless of whether such injury, death, damage or loss was caused in whole or in part by any negligent act or omission of any Ani's Party. The terms and conditions of this section shall survive any termination of this Application.

Applicant's Signature

Date

Please verify that you are human*