Puppy Adoption Form

Perspective Dingo Parent*

First NameLast Name

Highlands Dingo Rescue

Adoption Application and Waiver

Name of Pet You Wish to Adopt*

Email Address*

Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Do you own any pets?*

Pet Name(s)

Pet Breed(s)

Pet (s) Sex

Pet's disposition and behavior towards other dogs?

Please provide your veterinarian's name and phone number:

Do you own or rent your home?*

OwnRent

Do you have a yard?*

YesNo

If "Yes" to the above, is it fenced? please describe

To help your application please provide photos of your fencing , yard, area or enclosure

What is your landlord's pet policy?*

If you rent, please provide your landlord's information here:*

Have you ever surrendered a pet you own to any animal shelter including a "low" or "no kill" shelter?*

YesNo

Are there children in the home? (If yes, please list ages)*

If you answered "Yes" to the above question, please provide detail:

How many hours per day would the pet be alone?*

Will you crate your pet?*

If you have to leave town, emergently or planned, where would your pet stay?*

How would you deal with behavioral issues such as chewing, destructive behavior, bathroom accidents indoors, unruly leash behaviors in your pet?*

Please provide the names, emails, and contact numbers for 3 personal references:*

Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment?*

YesNo

If you answered "Yes" please provide a detailed description:

By clicking the submit button, I agree to Highlands Dingo Rescue. adoption process, will undergo a homecheck, and interview at the discretion of Highlands Dingo Rescue
By clicking the submit button, I understand Highlands Dingo Rescue will check my references, including veterinary and personal.
By clicking the submit button, I understand there is an adoption fee associated with the pup's adoption. This adoption fee covers Vaccinations, microchip, desexing and worming
By clicking the submit button, I agree to indemnify and hold harmless Highlands Dingo Rescue against any losses, lawsuits, claims, injury, or damages incurred by me or to any persons or property by my adopted pet once adoption has been completed.
By clicking the submit button, I understand that Highlands Dingo Rescue will disclose any of the pet's health or behaviour issues known by the rescue named above group before the adoption is completed.
By clicking the submit button, I understand that if I no longer want my pet or am no longer able to care for my adopted pet, I will be directed to surrender my pet to Highlands Dingo Rescue and provide transport to where Highlands Dingo Rescue deems appropriate.
By clicking the submit button, I agree to pay for any transport costs required for the pup to my destination.
By clicking the submit button, I verify all of the above information is true and accurate.

Signature of Potential Dingo Parent*