RACE Adoption Form 2020

503 Red Fox St NW, Shallotte, NC 28459
www.raceshelter.org racerescue@atmc.net Facebook R.A.C.E Inc

ADOPTION APPLICATION
No application fee

Adoption Fees
$250 for dogs and puppies, $150 for senior dogs (10 and over)
Date

MonthDayYear
Date
Name of animal you are applying for
Breed of animal you are applying for
Gender
How did you hear about this animal?

FacebookWebsitePawprintsPawPrintsOther
Other, please list
Name

First NameLast Name
Address

Street Address

Unit #

CityState / Province

Postal / Zip Code
Place of Employment
Work Phone Number

Area CodePhone Number
Email
example@example.com
Driver's License #
Driver's License State
Do you own, rent or share a home?

OwnRentShare
Development Name
Landlord Name, if renting or sharing, enter N/A is not applicable
Landlord Phone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Daytime Number

Area CodePhone Number
Did you enter a work or home daytime number?

WorkHome
Number of other adults living in home
Names and ages of children in home
Has anyone been convicted of animal cruelty or neglect?

YesNo
Do you have a fenced in yard?

YesNo
Where will your dog stay when you are not at home?

CrateFree
Where will your dog sleep at night?

CrateBedFree
How many hours will your dog be alone each day? (enter 1 if less than 1 hour, or enter a single number, please do not enter 1-2, 3-4, as it leaves the entry blank when submitted)
Name of nearest relative not living with you?

First NameLast Name
Relative's Phone Number

Area CodePhone Number
Relative's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Names of current pets or pets owned in last 5 years, please note if the pets listed are currently living or deceased.
Name of Current Veterinarian
Vet City Location
Vet Phone Number

Area CodePhone Number
Name of Veterinary Office
Owner's Name on Vet Records
Are your current pets spayed or neutered? Yes or No?
Where where your pets spayed/neutered?
Are your pets current on vaccines/heartworm preventative?
Please enter initials to following agreement entries:
I understand I am responsible for protection, care and medical treatment of this pet; initial here:
I agree I am financially able to care for this pet, including accident and illness; initial here:
I understand that at no time will this dog live outside under any circumstances; initial here:
I understand that at no time will this dog be tied or chained outside in any yard; initial here:
I agree to obey all applicable ordinances and laws governing control and custody of pets; initial here:
I agree to place place ID tag with name, address and phone number on pet; initial here:
I agree to allow RACE to follow up on pet and take legal action to protect adopted pet; initial here:
I understand RACE can’t guarantee health, temperament or behavior of pets and hereby release RACE from claims of liability, injury or damage to persons or property once I adopt; initial here:
I understand I will return pet to RACE if I can no longer care for or house the pet; initial here:
I understand RACE has provided me with all records and information pertaining to pet and that it is accurate to the best of their knowledge and I accept the pet based on my judgement of pet’s current condition and personality; initial here:
I understand the adoption fee is a donation and is non-refundable; initial here:
Electronic Signature:
Should be Empty:

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