Puppy Adoption Form

Adoption Application, Contract and Waiver

For Creekside Chesapeakes.

Perspective Pet Parent*

First NameLast Name

Perspective Pet Co-Parent (optional)

First NameLast Name

Collar Color of Pet You Wish to Adopt*

Collar Color

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 Breed(s)

Any comments about your current pet's disposition and behavior towards other pets?

Please provide your veterinarian's name and phone number: (optional)

Full registrationLimited registrationNot sure

MaleFemaleUndecided

Please briefly describe your interest in owning a Chesapeake Bay Retriever.

YesNo

YesNoUndecidedPlanned Breeding

OwnRent

If you Rent / Lease your home, what is the current pet policy in your landlord/Tenant contract?

YesNo

If yes, please describe. (fenced, size, etc.)

YesNo

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

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

Yes (regularly)NoAt night onlyOccasionally

If you have to leave town, emergently or planned, Do you have a plan for alternate care for your pet? Please briefly describe?*

How would you deal with behavioral issues such as barking, chewing, destructive behavior, bathroom accidents, and any other unwanted behaviors?*

YesNo

18 - 2526 - 3536 - 4546 or Above

#1 Reference

First NameLast Name

#1 reference phone number*

Area CodePhone Number

#1 reference Email Address*

example@example.com

#2 Reference

First NameLast Name

#2 reference phone number*

Area CodePhone Number

#2 reference Email Address*

example@example.com

#3 Reference

First NameLast Name

#3 reference phone number*

Area CodePhone Number

#3 reference Email Address*

example@example.com

By clicking the submit button, I agree to Creekside Chesapeakes adoption process, will undergo a homecheck, and interview at the discretion of Creekside Chesapeakes.
By clicking the submit button, I understand Creekside Chesapeakes will check my references including veterinary and personal.
By clicking you are submitting this form for yourself as an owner and not a representative or broker for any other persons, pet shop, or animal institution.
By clicking the submit button, I understand there is no "cooling off" period, and that if I no longer want or can no longer care for my adopted pet, I agree to notify Creekside Chesapeakes BY EMAIL and Phone, as well as provide a 14 day period to allow Creekside Chesapeakes to make arrangements for my pet to be taken back, and agree that associated costs could be involved for the return.
By clicking the submit button, I agree to have Creekside Chesapeakes be listed as an alternate contact in the Avid PETrac data verification microchip recovery service protection.
By clicking the submit button, I agree to notify Creekside Chesapeakes anytime my pet is lost or stolen. Creekside Chesapeakes has a network to aid in the recovery of a lost or stolen pet.
By clicking the submit button, I agree to notify Creekside Chesapeakes in the event of any litters from your pet, either by stud or pregnancy terms. (this is for our records, We view our pets as family)
By clicking the submit button, I agree to follow the terms of the adoption agreement fully including limited or full AKC registrations.
By clicking the submit button, I agree to indemnify and hold harmless Creekside Chesapeakes against any losses, lawsuits, claims, injury, 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 Creekside Chesapeakes will disclose any of the pet's health or behavior issues known at time 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 Creekside Chesapeakes and provide transport to where Creekside Chesapeakes deems appropriate.
By clicking the submit button, I agree I have painstakingly read all of this info and understand that Creekside Chesapeakes is requiring this information and agreement because Creekside Chesapeakes truely cares about the pets (family members) we provide.
By clicking the submit button, I verify all of the above information is true and accurate.

YesNo

Signature of Potential Pet Parent*