Cozze Paws Rescue Adoption Application
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Place of employment
Name, or ID number of dog you are interested in
Do you currently live in a:
House
Apartment
Condo
Other
Do you currently:
Own
Rent
Lease
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?
Companion
Search & Rescue
Guard dog
Agility
Hunting
Jogging
Obedience training
Walking buddy
Couch warmer
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
High energy
Outdoorsy
Lap dog
Mellow
Affectionate
Quiet
Guard dog
When it comes to relating to dogs I tend to be more
Strict, demanding (dog must learn and follow commands)
Moderate (encouraging of good behavior)
Lenient (easily coerced by the dog)
The noise/activity level in my home is usually:
High
Medium
Low
I would enjoy brushing, or grooming my dog:
Rarely
Occasionally
Daily
Weekly
Monthly
I would prefer a dog that:
Would enjoy walking with me on a leash
Will exercise him/herself in our yard
Would enjoy going to the dog park
Would run, jog, or hike with me
Requires only enough exercise to do his/her business
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
-
Month
-
Day
Year
Date
Submit
Should be Empty: