Pet Adoption Application Form

Name of Pet You Wish to Adopt*

Perspective Pet Parent*

First NameLast Name

Email Address*

example@example.com

Spouse or Significant Other in Household

First NameLast Name

Children in the home?*

Yes-Full timeYes-Part timeNo or Very Rarely

If Yes, please list ages

If Yes, have they been around dogs in the home?

i.e. Breed types, puppy/elderly, etc...

Phone Number*

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Name of employer:*

Address of employer

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Length of employment:

How would you describe your home?*

Very ActiveSomewhat ActiveRather Calm

Dou you currently own any pets?*

YesNo

If Yes-

pleas list each Pet(s) Name/Breed/Age/Gender

Your pet's disposition and behavior towards other dogs/cats?

Why do you think this particular pet is a good fit for you/your family...

Please provide your veterinarian's/Clinic name, address 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 fencing

What is your landlord's pet policy?*

If you rent, please provide your landlord's information here: *A copy of the pet lease will be required before finalization of adoption.*

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

YesNo

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 barking, chewing, destructive behavior, bathroom accidents indoors, unruly leash behaviors in your pet?*

Please provide the names, emails, and contact numbers for 2 personal references (at least 1 non-family member):*

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 Double D Delightful Dogs Rescue adoption process, and will interview at the discretion of Double D Delightful Dogs Rescue.
By clicking the submit button, I understand Double D Delightful Dogs Rescue will check my references including veterinary and personal.
By clicking the submit button, I understand there is a monetary adoption donation of $________ associated with adoption of a pet and that it is tax deductible according to IRS 501(c)3 guidelines. I understand this donation will ensure the organization is equipped to rescue another homeless pet.
By clicking the submit button, that if I no longer want or can no longer care for my adopted pet, I agree to notify Double D Delightful Dogs Rescue. BY EMAIL or Phone and provide a 14 day period to allow the rescue to make arrangents for my pet to be taken back into the rescue.
By clicking the submit button, I agree to indemnify and hold harmless Double D Delightful Dogs Rescue 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 Double D Delightful Rescue will disclose any of the pet's health or behavior issues known by the above named rescue group before adoption is completed.
By clicking the submit button, I will adhere to all city ordinances, as well as providing appropriate care for my pet. If at anytime I am found not caring for my pet(where injury or serious health conditions could occur) &/or continue to break city ordinances or continue to allow my pet to be in harms way, Double D Rescue has the right to revoke my ownership and regain possession of said pet
By clicking the submit button, I verify all of the above information is true and accurate.

Signature of Potential Pet Parent:*

Signature date

Date

ADOPTION APPLICATION, CONTRACT & WAIVER FORM