Adoption Application Dog NKGC

Adoption Application

Thank you for taking the time to fill out this application. Your information will remain confidential and used only as part of the NKGC Adoption Program. ***Must be at least 21 years of age ***Must agree to allow us to photograph and publish on social media***
Name of Dog you are interested in adopting
Name

First NameLast Name
Co-Applicant Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
1st Phone Contact

Area CodePhone Number
2nd Phone Contact

Area CodePhone Number
How did you hear about NKGC?
Why do you want to adopt?
Information about your household
Humans- Names, Ages, & Occupations
Current Dog(s) - Name, Age, Breed, Gender, Altered, Comfortable with dogs? *
Current Cat(s) – Name, Age, Gender, Altered, Comfortable with dogs? *
Current Other Pet Types - Type, Age, Comfortable with dogs? *
Upload copy of vaccination records on each pet. Or email to nokillglynncounty@gmail.com

Browse Files

Cancelof
If you do not have a dog now, have you ever owned a dog for which you were the primary caretaker?

YesNo
If yes, what happened to the dog(s)?
If you do not have small children living in your home, will your Rescue Dog come into regular contact with any children under the age of 10?

YesNo
If Yes, how often and what ages?
Does anyone in your house have allergies to animals? *

YesNo
Do you rent or own your home?

RentOwn
How long have you been at your current residence?
If at current residence less than a year, please give previous address:
If you rent, has your landlord provided written permission for you to have a dog?

YesNo
Please provide your landlord’s name & phone #:*
Do you have a fenced yard? *

YesNo
If yes, please describe the fence (Type, Width, Length, Height):
If you don't have a fence, are you willing to install one or do you have a plan to install one?
If no, please indicate why not?
Do you have a swimming pool? *

YesNo
Information on how you will care for your adoptive dog
Who will care for, train and exercise the dog? *
Are there any physical or mental conditions that may prevent you from giving care to your dog? *
How many hours a day will you exercise your Dog? *
Where will your Rescue Dog be kept during the day? *
How many hours per day will your dog(s) be alone (without humans) on a regular basis – not including lunch breaks? *
Will the dog(s) be allowed in the house? *

YesNo
Will the dog(s) have the free run of the house? *

YesNo
Will the dog(s) be kept out of certain areas in the house? *

YesNo
If the dog will be kept out of certain areas in the house explain what area and why.
Are you familiar with crate training? *

YesNo
Are you willing to use a crate for your Rescue dog? *

YesNo
Will the dog(s) be kept on a runner or tied outside? *

YesNo
Will the dog(s) live in the yard? *

YesNo
Will the dog(s) live in the yard? *

YesNo
Will the dog(s) be walked daily? *

YesNo
Will the dog(s) be exercised in a fenced yard? *

YesNo
Will the dog(s) be allowed to run free outside of a fenced yard? *

YesNo
References

**Please contact your vet’s office to authorize them to speak with NKGC. Failure to do so could delay the processing of your application.
Veterinarian, Phone number & Address? *
If you haven’t been with this vet for your pet’s entire life, please also provide us with your previous vet’s contact information.
Personal References - Not a relative or household member (name, phone & relationship)
Reference #1 *
Reference #2 *
Miscellaneous Questions
May we visit your home prior to application approval? *

YesNo
Have you sold, given away, or surrendered a pet to a shelter, pound or Humane Society? *

YesNo
If yes, please provide details:
Do you understand the state and local ordinances concerning licensing? *

YesNo
Do you understand the state and local ordinances concerning leashing? *

YesNo
Have you or any member of your family/household been cited for leash law violations or animal cruelty? *

YesNo
If yes, please provide details?
Are you aware a rescue dog may take time and adjustment to settle into your home? *

YesNo
PREFERENCE QUESTIONS
Do you have any size, breed or weight requirements for your dog?
Are you ready to adopt this dog immediately? *

YesNo
AGREEMENT

I/We attest that I/we understand that NKGC makes no guarantees or statements regarding any dog's age, breed, health, or temperament. While NKGC has made every effort to provide accurate history and assessment of all of the dogs, NKGC is not able to guarantee any dog’s age, breed, medical status or history, behavior or disposition. I/We hereby release NKGC and its employees, directors, members and representatives of any and all possible claims arising from injury or damage caused by any dog adopted by me/us to any person or property or relating to the health or temperament of the dog, including any expenses related thereto.
I/We, the undersigned Adopter's understand and agree to the following terms and conditions of this contract to adopt the dog, further described within this document. I/we understand that non-compliance with the terms of this agreement gives No Kill Glynn County (NKGC) the right to reclaim this dog.In the event the adopter can no longer keep or provide for the dog, without refund of the adoption fee or other compensation. The contract shall remain in effect for the life of the dog, or until the return of the dog to Owner. If the dog is to pass the adopter is to provide proof of the dog's passing from a vet.
By signing this form, I/we acknowledge that all information on this form is true and correct. I/We understand that any misrepresentation of fact may result in NKGC refusing adoption privileges to me. I/We authorize NKGC to contact all veterinarians listed on the application and the landlord if applicable. If my request for adoption is approved and later NKGC discovers the above information is not true or correct, NKGC reserves the right to remove the adopted dog from my home.
Signature
Date

MonthDayYear
Date
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Adoption Application

Information about your household

Information on how you will care for your adoptive dog

References

Personal References - Not a relative or household member (name, phone & relationship)

Miscellaneous Questions

PREFERENCE QUESTIONS

AGREEMENT