FBS Dog Adoption Application

*To ensure committed and to aid in the expenses for application processing, an application donation of $10 is required. Payment options are at the bottom of this form. An application will not be reviewed without fee submission. This fee is non-refundable and does not guarantee application or adoption approval. If an adoption is finalized, the fee goes towards the adoption fee of $175.

*Incomplete applications will not be processed. Common mistakes are missing or incorrect phone numbers.

*Please know we cannot approve everyone for the same dog or puppy. If you're not chosen it doesn't mean you are unfit for adoption. Please consider listing more than one animal you maybe interested in on your application or let us know if another dog in the future fits your lifestyle.

*Please feel free to stay in contact with us via email. It is just two of us that run daily operations and sometimes we need a reminder! We appreciate your patience!

Applicant Name *

First Name Last Name

Age *

Co-Applicant Name *Required if living with anyone over the age of 18 yrs* Put N/A if living alone. *

First Name Last Name

Age of Co-Applicant

Relationship Between Applicants *

Married Engaged Dating *If dating, Applicant is primary adopter and assumed to be responsible for the animal if the relationship dissolves.

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number

Area Code Phone Number

Email *

example@example.com

Do You: *

Rent Own

Do you live in a: *

House Townhouse/Duplex Apartment/Condo

Property/Landowner Name: *Required if Renting*

First Name Last Name

Property/Landowner Phone Number (by providing this information, you are allowing FOR BELLE'S SAKE to contact your landlord. Please inform them of this call. Used to verify pet allowance.)

Area Code Phone Number

How many adults over 18 years live in your household? *

Ages of children in the home: *

Is everyone in agreement with the decision to adopt a dog? *

Yes No

Do you have time to provide adequate affection and attention? *

Yes No

For what reason(s) would you/your family surrender a dog or other pet to another home or shelter? Be specific: *

What will you do with the dog if you have to move or Permanently Change Station? *

Current Pets: What other pets do you have (specify type/number/name: *

Have you ever surrendered a pet? If yes, why? *

Have you ever given away or sold a pet? If so, why? *

Have you ever had a pet euthanized? If so, why? *

Have you ever lost a pet to an accident or lost a pet? If so, what happened? *

Do you have a regular Veterinarian? *Required if not a first time pet owner* Application will not be processed if a vet reference is not provided and not a first time pet owner. Include all past vet references. (By providing this information, you are allowing FOR BELLE'S SAKE to call your vet. Please inform them of our call and authorize release of information)

Clinic Name

Street Address

City State / Province

Postal / Zip Code

Clinic Phone Number *Required if not first time pet owner* We will not look this information up. If not provided, application will not be processed.

Area Code Phone Number

Contact information for additional Veterinarians used if applicable:

Name(s) of the dog(s) you are interested in meeting/adopting? *

Willing to adopt: *

outgoing/hyper dog shy dog dog that needs regular medication dog that needs training (we do not guarantee housetraining for any canine) dog that needs grooming none of these

Do you plan to keep the dog as an indoor dog or strictly outdoors: *

Indoor/Outdoor Outdoor only Outdoor with access to garage/barn

When outside, how do you plan to keep your pet: Check all that apply *

Tie out chain Garage Patio area Invisible fence Fenced yard Dog run Loose in yard Leash only

Do you have a yard: *

Yes No

Is it securely fenced on all sides? *

Yes No Partial Fence N/A

If yes, how tall in feet: *

Do you agree to contact For Belle's Sake immediately if you can no longer keep this dog for any reason regardless of the time passed and allow For Belle's Sake time to provide adequate placement? *

Yes No

Do you agree to travel to the rescue for a meet and greet/adoption if approved? We require meet and greets take place at rescue and do not transport *

Yes No - Unable to

Do you agree that all current dogs in the household are required to attend the meet and greet and children are highly encouraged to be in attendance? *

Yes No

Personal Reference: Please list a reference familiar with you, your pets, and your home environment. Please inform them of our call. *

First Name Last Name

Reference Phone Number *

Area Code Phone Number

We are committed to helping find perfect fits and are so grateful you are wanting to adopt a homeless dog! Please share any additional information you would like to add about your story and journey.

ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM (required) Read and submit with your adoption application. This form is used in the event a meet and greet is scheduled to protect the rescue and their board members/volunteers from accidents that can occur when dealing with animals (scratches, etc).I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES ASSOCIATED WITH THIS EVENT, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault.I certify that there are no health-related reasons or problems which preclude my participation in this activity.I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of the activity in which I may participate, and that it will govern my actions and responsibilities at said activity.In consideration of my application and permitting me to participate in this activity, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:(A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this activity, THE FOLLOWING ENTITIES OR PERSONS: For Belle’s Sake Rescue and Rehabilitation, (FBS) and/or their directors, officers, employees, volunteers, representatives, and agents, and the activity holders, sponsors, and volunteers;(B) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise.I acknowledge that FBS and their directors, officers, volunteers, representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf.I acknowledge that this activity may involve risks. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of participants, equipment, and actions of other people including, but not limited to, participants, volunteers, monitors, and animals involved. These risks are not only inherent to participants, but are also present for volunteers.I hereby consent that medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity for myself, members who accompany me, and/or my pets is at my own expense and discretion.I understand while participating in this activity, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the activity holders, producers, sponsors, organizers, and assigns.The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. BY SUBMITTING, I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL. *

First Name Last Name

$10 Adoption Application Donation - Required - Non-refundable. An application will not be reviewed without fee submission. This fee is non-refundable and does not guarantee application or adoption approval. If an adoption is finalized, the fee goes towards the adoption fee of $175.

USD Application Donation - Required - Non-refundable

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