Cozze Paws Rescue Adoption Application

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Phone Number

Area CodePhone Number

Email

example@example.com

Place of employment

Name, or ID number of dog you are interested in

Do you currently live in a:

Do you currently:

How long have you lived at your current residence?

If you are not the property owner, we will need to verify your landlord's current pet policy

Landlord's name

Landlord's phone number

How many adults live in the home?

Ages of the adults

How many children live in the home?

Ages of children in the home

Does anyone in the home have allergies?

Who will primarily be responsible for the care of this dog?

Which of the following best describes your reasons for wanting this dog?

How many hours will the dog be alone each day?

Where will the dog be kept when no one is home?

Where will the dog be kept at night?

Do you have a fenced yard? If so, please describe height and construction type, i.e. wood

If you have other pets are their vaccinations current?

Are they currently licensed?

Who is your regular veterinarian?

Phone number for veterinarian

Under what circumstances would you not keep this dog?

Please list all the pets you have had in the last 7 years, including current pets and those you no longer own. Please also list type of pet, age, how long you had, if they were altered, what happened to them

Please describe the temperament and activity level you are looking for in a dog

When it comes to relating to dogs I tend to be more

The noise/activity level in my home is usually:

I would enjoy brushing, or grooming my dog:

I would prefer a dog that:

My ideal dog would:

Bad habits I cannot tolerate are:

Please intial the following:

I understand and agree that Cozze Paws Rescue makes no express, or implied, warranty, representation, or promise as to the age, health, breed, habits, disposition. I hereby accept the animal as is, assume all risks and responsiblities associated with the ownership of the animal, including bites, and I hereby fully and completely release, indemnify, and hold harmless Cozze Paws Rescue, its directors, officers, volunteers, servants, and emlpoyees from any claim, cause of action or liability of any sort or nature, whether knowm, or unknown, directly, or indirectly arising out of or in connection with the adoption, care of ownership, maintenance, temperament or condition of the animal.

I agree in the case I cannot keep the animal I will contact Cozze Paws Rescue. The rescue has the option to take the animal back into the care of the rescue at their discretion.

All monies deposited with CPR will be considered a donation to the rescue and are non-refundable

I acknowledge the falsification of the above can result in my being denied adoption of an animal, or if animal has been adopted to me, the return of that animal to CPR

I certify the above information is true and correct to the best of my knowledge.

Signature

Date