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

Name of animal you are applying for

Breed of animal you are applying for

Gender

How did you hear about this animal?

Facebook Website Pawprints PawPrints Other

Other, please list

Name

First Name Last Name

Address

Street Address

Unit #

City State / Province

Postal / Zip Code

Place of Employment

Work Phone Number

Area Code Phone Number

Email

example@example.com

Driver's License #

Driver's License State

Do you own, rent or share a home?

Own Rent Share

Development Name

Landlord Name, if renting or sharing, enter N/A is not applicable

Landlord Phone Number

Area Code Phone Number

Cell Phone Number

Area Code Phone Number

Daytime Number

Area Code Phone Number

Did you enter a work or home daytime number?

Work Home

Number of other adults living in home

Names and ages of children in home

Has anyone been convicted of animal cruelty or neglect?

Yes No

Do you have a fenced in yard?

Yes No

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

Crate Free

Where will your dog sleep at night?

Crate Bed Free

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 Name Last Name

Relative's Phone Number

Area Code Phone Number

Relative's Address

Street Address

Street Address Line 2

City State / 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 Code Phone 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: