ADOPTION APPLICATION

Have you ever had to give up a pet?*

If yes, why and to whom?

Are all of the pets in your household current on vaccinations?*

Are all cats in your household tested for Feline Leukemia/FIV?*

Are all dogs in your household on heartworm prevention?*

What kind of heartworm prevention do you use?*

What is the date of last heartworm prevention given?

Date

Do you use Flea & Tick prevenion in your home?*

Brand?*

Have any pets in your household been diagnosed with infections diseases or conditions?*

	Yes	No	N/A
Heartworms
Distemper
Parvovirus

Please list all pets currently living at your address, ALL boxes for each pet must be completed to move forward in the application process. If no pets, use N/A.*

	Pet Name	Species	Breed	Age	Years Owned	Spayed Neutered
#1
#2
#3
#4
#5

Please list pets owned in the last 5 years that are no longer with you:

	Pet Name	Species	Breed	Age	Years Owned	Spayed Neutered
#1
#2
#3
#4
#5

Why are the pets listed above no longer with you?

	Pet Name	Reason
#1
#2
#3
#4

Do you have a current veterinarian?*

Vet Name (Current or Vet you are planning to use)*

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

Can your current vet confirm your pets vet history, vaccines and/or spay/neuter?*

If no, please provide the name of the vet that can confirm current vetting:

Vet's Name:

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Please describe the extent of care that you are willing to provide, should your pet have special medical needs now or later in life:*

When was your last vet visit?*

Date

What was the reason for your last vet visit?*

I, First Name Last Name hereby give permission for any veterinarian providing service to me to release medical information on any/all of my animals to APAC. This release is for follow-up purposes in the case of existing conditions or simply well check for vaccines, spay/neuter status and heartworm prevention status.

The animals in APAC’s foster care are not merchandise. They are living beings entrusted to our care. It is our responsibility to find the best possible homes for them and to meet the individual needs of each animal. Therefore, we have the right to approve or deny any adoption as we see fit.

I/We are applying to adopt the Dog described in the attached Application from APAC and take responsibility for this animal.

This animal is Fully Vetted at this time (Parvo, Distemper, Rabies), is spayed or neutered, and has been Heartworm tested if older than 7mo. All vet records will be provided to me at time of final adoption process.

This document will also serve as the adoption contract agreement should adoption result from application.

HW Test result:

This will be in the pet profile, or can be completed by APAC Foster

If this animal is still a puppy (under 5 months of age) additional vetting may be required and included in the adoption fee.

This animal is still a Puppy and although it has age-apropriate vetting, additional vetting is required. Adoption is effective with this signed agreement, and I/We agree to complete the required follow up as scheduled, in order to completely finalize and close this adoption.

Should the need arise, I will reach out to APAC to request a return to the rescue. When returned within two weeks of adoption, there will be no surrender fee. The return will be based on availability of foster home openings.

I/we certify that the above information is true and correct. I/we understand that false information may result in nullifying this adoption. I agree to discuss the dog I am interested in adopting with the foster family and ask questions to help ensure the dog is a good fit for my home. While foster families strive to provide all the information available on the foster dog being adopted, I understand that the dog may behave differently during the adjustment period in my home. I understand animals can be unpredictable in various situations and will not hold APAC or any representatives responsible for injuries or damages caused by the dog I am adopting.

Name of Adopter*

By Typing your name here you agree to the above

Signature*

Date*

Date

Spouse, Roommate or Partner name

Spouse , Roommate, Partner agree to same

Signature

Printed Name of Foster

Upon Submission, this application is sent directly to APAC Rescue for review. Please allow 24 hours for a response.

For questions please contact us at (254) 541-1461 or myhappytail@yahoo.com or contact us on Facebook.com/groups/APACTempleTX

ADOPTION APPLICATION

Personal Information

Pet Care

Pet Ownership & Vet History

Release for Veterinary Reference:

APAC Adoption Agreement: