Dog adoption application

Thank you for your interest in adopting one of our dogs. Please fill out all of the information below in order to have your application processed.

This application is soley used to determine the best fit for you, and the dog. This does not gurantee the dog you apply for, will be yours. Your information will remain confidential and only used as apart of adoption process.

Name *

First Name Last Name

Todays Date *

Date

Date of birth *

Date

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

E-mail *

Phone Number *

Area Code Phone Number

Phone Type *

Cell Home Work

When will you be ready to adopt? *

Today This weekend Within a week Within a month

How many residents are living in your home? *

Names and ages of all permanent residents in your home (adults/children) *

I/We live in a *

Single Family Home Duplex/Twin Condo/Townhome Trailer Apartment

Do you rent or own this property? *

Rent Own

Do you plan on moving? if so, please explain how far and where you will be moving to. *

Renters, have you contacted your landlord to find out if there's any restrictions on the kind or size of dog you can have?

Yes No Not yet, but I will It's written in our lease

Do you have a yard? *

Yard, fenced with a vertical fence Yard, fenced with invisible fencing Yard, no fence No yard (apartment/condo/townhome)

Do you currently have any pets living in the home? *

Yes No

If you currently have pets, please list them below.

Are the current pets in your home neutered/spayed?

Yes No Will be within the next 30 days, appointment has been scheduled. (We will call your vet to verify this.)

If your current pets are not altered, please explain why below.

Are the pets living in your home up to date on shots?

Yes No Will be within the next 30 days, appointment has been scheduled. (We will call your vet to verify this.)

Vet reference (please call your vet and give permission to release information to us)

Vet name, address & phone number

Is anyone in your home allergic to dogs? *

Yes No

Does anyone in your home fear dogs? *

Yes No

Do you work outside the home? *

Yes No One applicant is home/works from home We work different shifts

If you work outside the home, how many hours per day are you away? *

How many hours per day will this dog be alone? & where will the dog be while alone? Please explain. *

Where will the dog be sleeping in the home? *

Have you ever gave your pet away or surrendered your pet? if so, why? *

Have you discussed adoption with all members of your household? *

Yes No

How would you describe your level of experience with dogs? *

EX: You've have many dogs in your life, Never had a dog, experienced in rescue/fostering dogs etc...

Are you applying for a certain dog? if so, please write the name of the dog below. *

Are you willing to work with a trainer if issues arise with the dog you adopted, that we did not previously know about before? *

If you do not have a certain dog in mind, is there any information you feel we need to know about what kind of dog you are looking to adopt?

Are you able to keep the dog separated from other pets in your home to allow a decompression period, if this is needed. *

What do you feel is a reasonable amount of time for an animal to adjust/decompress to living with you/your family? *

What would cause you to return the animal? *

Additional reference (if desired)

Do you have any additional comments, questions or general concerns? Anything else you would like us to know to help match you up ? *

Terms and Conditions:

I/We, the above-referenced Adoptive Parent(s), acknowledge, agree, certify to, and agree to be legally bound by the following terms and conditions:

1. Certification.

I/We hereby certify that I/we: (a) have never been charged with animal cruelty and am/are not an animal dealer, broker or breeder; (b) have considered my/our lifestyle and have the time and patience enough to care for the Adopted Animal; and (c) am/are prepared to assume all financial responsibility for adopting and caring for the Adopted Animal.

2. Decompression/Separation:

I/We hereby agree that I/we will take physical custody of the Adopted Animal and give the Adopted Animal at least five (5) and up to fourteen (14) days or more to adjust to his/her new surroundings and for the family and other resident pets to adjust to the Adopted Animal by separating the Adopted Animal from the family, visitors and other resident pets.

3. No Guarantee:

I/We hereby agree to adopt the Adopted Animal as is, and understand and acknowledge that Philly Rescue Angels Inc. does not provide any warranty, representation, or guarantee whatsoever relating to or associated with the Adopted Animal, including, but not limited to, its lineage, or present and/or future health, medical condition, temperament, and behavior.

I/We also understand and acknowledge that any animal, including the Adopted Animal, may be prone to medical or genetic conditions not readily evident. I/We further understand and acknowledge that any rescue animals, including the Adopted Animal, have no history and may not show their true nature or health for some time after placement with the Adoptive Parent(s). I/We understand that by choosing to adopt the Adopted Animal, I am/we are taking full responsibility, as its new owner(s), to care for any unknown, pre-existing or future illnesses the Adopted Animal may have.

4. Sterilization:

Assuming the Adopted Animal is not already sterilized prior to adoption from Philly Rescue Angels Inc., I/We hereby agree to spay or neuter the adopted animal by a licensed veterinarian by the following date:   Date   I/We must provide proof of sterilization to Philly Rescue Angels Inc. by way of a certificate or letter from the licensed veterinarian within ten (10) days of the sterilization date. Philly Rescue Angels Inc. will cover the cost of sterilization if I/We use an approved vet partner of Philly Rescue Angels Inc., which approval must be obtained by me/us from Philly Rescue Angels Inc. prior to such sterilization. I/We further agree to be responsible for all costs associated with such sterilization of the Adopted Animal if using my/our own vet, and I acknowledge that Philly Rescue Angels Inc. will only reimburse me $100.00 if using my/our own vet to sterilize my Adopted Animal.

5. Microchipping:

Assuming the Adopted Animal is not already microchipped prior to adoption from Philly Rescue Angels Inc., I/we hereby agree to microchip the Adopted Animal by a licensed veterinarian or other service provider by the following date:   Date  or during the time of sterilization. I/We must provide proof of microchip to Philly Rescue Angels Inc. by way of a certificate or letter from the licensed veterinarian or service provider within ten (10) days of the microchip implantation date. Philly Rescue Angels Inc. will cover the cost of the microchip implantation only if I/we use an approved vet partner of Philly Rescue Angels Inc., which approval must be obtained by me/us from Philly Rescue Angels Inc. prior to such implantation. I/We agree to be responsible for all costs associated with such microchip implantation of the Adopted Animal if using my/our own vet. I/We further agree to be responsible for all costs associated with the registration and maintenance of such microchip of the Adopted Animal whether or not I/we use my/our own vet or an approved vet partner of Philly Rescue Angels Inc.

Adoptive Parent(s) Initial(s):     Signature

Purpose of Adoption and Care:

I/We hereby understand and acknowledge the duties and responsibilities associated with adopting, owning and maintaining the Adopted Animal, and hereby agree to:

making the Adopted Animal a companion pet and welcome member of the household for as long as the Adopted Animal shall live.

keeping the Adopted Animal as a house pet that will live in the family home.

obeying and complying with any and all applicable federal, state and local laws, regulations and ordinances governing his/her/their ownership, control and custody of the Adopted Animal, including, but not limited to, licenses.

  4. caring and providing for the Adopted Animal for as long as the Adopted Animal shall live, including, but not limited to, by providing it adequate shelter/housing, adequate attention, safe containment, a healthy diet and nutrition (including adequate food and water), adequate exercise, positive training and obedience, and any and all veterinary care (including, but not limited to, annual medical checkups, vaccinations, deworming, flea/tick/heartworm prevention, other care as required or recommended by a veterinarian, and emergency treatment as needed);

6. providing a safe collar with rabies and identification tags

7. keeping the Adopted Animal under my/our control and supervision when it is not on my/our property;

8. maintaining the Adopted Animal’s microchip registration with current contact information;

9. not confining the Adopted Animal by chain, rope, trolley or allow the Adopted Animal to run at large unless in a secured and confined area;

10. not debarking or declawing the Adopted Animal.
11. not subjecting the Adopted Animal to cosmetic surgery, including, but not limited to, ear cropping or tail docking.

Reservation of Rights:

I/We hereby agree that if Philly Rescue Angels Inc. determines that the Adopted Animal is being or was mistreated, abused, neglected or abandoned in any way, or that I am/we are in breach of this Agreement, that Philly Rescue Angels Inc. maintains the right to inspect my/our premises at any time and unannounced, and to repossess the Adopted Animal at any time with no credits or refunds to me/us. If such action occurs, I/we shall be responsible for all costs and expenses (including attorneys’ fees) associated with Philly Rescue Angels Inc. taking such action.

Custody of Adopted Animal:

I/We hereby agree that, in the event that I/we cannot or will not adequately provide for or keep the Adopted Animal, I/we must return it to Philly Rescue Angels Inc., and that I/we will never abandon, sell, give, release or otherwise transfer the Adopted Animal to any individual, shelter or other rescue organization without the express prior written consent of Philly Rescue Angels Inc.

Prior Notification of Any Change of Address:

I/We hereby agree to notify Philly Rescue Angels Inc. prior to any time that I/we may move from my/our current residence

Adoptive Parent(s) Initial(s): Signature

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNIFICATION:

I/We, for myself/ourselves and for my/our family, heirs, executors, administrators, legal representatives, and assigns, fully understand, acknowledge and agree that: because the Adopted Animal came to Philly Rescue Angels Inc. as a stray, stray or owner surrender from a shelter or as an owner surrender directly from its prior owner(s), it is impossible to obtain a health history or other information for the Adopted Animal, including behavioral history; Philly Rescue Angels Inc. is without knowledge of any health or behavior problems or concerns that the Adopted Animal may have had in the past or will have in the future, but has disclosed fully any known healthy or behavioral history as noted above; the adoption, care and control of an animal may involve inherent risks and dangers of bodily injury or death to person and/or damage to or loss of service of property, and/or other, and that the adopted animal may have a propensity to bite and/or scratch, whether or not when provoked, threatened, scared or being protective (collectively, “Risks”); these Risks may be caused by my/our own actions or inactions, the actions or inactions of others, the condition in which the bodily injury to person and/or damage to property takes place, or the fault or negligence of Philly Rescue Angels Inc.; there may be other risks and social and economic losses either not known to me/us or not readily foreseeable at this time; Philly Rescue Angels Inc. cannot and will not assume any liability or responsibility for such risks or other risks, social or economic losses; and I/we fully accept and assume any and all such risks, other risks and liabilities, full responsibility for, and agree to defend, indemnify and hold harmless Philly Rescue Angels Inc., its administrators, directors, agents, officers, members, volunteers, and employees, from and against any and all losses, costs, damages and liabilities incurred by me/us or any third party as a result of the adoption, care and control of the Adopted Animal by me/us.

I/We hereby fully release, discharge, and covenant not to sue Philly Rescue Angels Inc., its administrators, directors, agents, officers, members, volunteers, and employees, from any and all liability, claims, demands, actions, causes of actions, suits, losses, damages or judgments on my/our account or others caused or alleged to be caused, in whole or in part, by my/our adoption of the Adopted Animal, the fault or negligence of Philly Rescue Angels Inc., its administrators, directors, agents, officers, members, volunteers, and employees, circumstances beyond the control of Philly Rescue Angels Inc. and its administrators, directors, agents, officers, members, volunteers, and employees, or otherwise.

I/We further agree that if despite this release and waiver of liability, assumption of risk, and indemnity.

I/We or anyone on my/our behalf makes a claim against Philly Rescue Angels Inc., or any of its administrators, directors, agents, officers, members, volunteers, and employees, I/We will indemnify, defend, save, and hold harmless Philly Rescue Angels Inc., and its administrators, directors, agents, officers, members, volunteers, and employees, from any and all litigation expenses, attorney fees, liability, damage, or cost which any of them may incur as the result of such claim.

By signing this Adoption Agreement, I/We, the above-referenced Adoptive Parent(s), hereby acknowledge(s), agree(s) and certify(ies) that:

I am/We are at least 18 years of age or older.

I/We have read and fully understand the above terms and conditions and acknowledge that they are reasonable.

I/We will abide by and be bound by same.

I/WE HAVE READ SECTION (RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNIFICATION), AND I/WE FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I/WE HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING THIS ADOPTION AGREEMENT, AND HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTENDS TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS ADOPTION AGREEMENT (INCLUDING, WITHOUT LIMTATION, THE RELASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY IN SECTION IS HELD TO BE INVALID, THE BALANCE NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT. DISCLAIMER:

By adopting an animal(s) from Philly Rescue Angels Inc. and by signing this Adoption Agreement: I/We understand, acknowledge and agree that Philly Rescue Angels Inc. is a registered 501(c)(3) non-profit charitable organization and not a for-profit business. Philly Rescue Angels Inc. does not sell animals. Philly Rescue Angels Inc. adoption fee may be considered a tax-deductible donation. Philly Rescue Angels Inc. adoption fees are NONREFUNDABLE. In the event I/We need to return or surrender my/our adopted animal to Philly Rescue Angels Inc., Philly Rescue Angels Inc. may, but is not required to, waive its surrender fee and if Philly Rescue Angels Inc. waives its surrender fee or return my/our adoption fee, Philly Rescue Angels Inc. may do so in its sole and absolute discretion.

Adoptive Parent(s) Initial(s):   Signature

Date: Date Adoptive Parent (1.) Signature

Print: Signature

Date:   Date

Adoptive Parent 2 (if applicable):   Signature

Print:   Signature

Please read the above, check this box, sign, and click Submit. *

I/We have read and understand all of the above.

After you submit this form, we will review the submission and contact you as soon as we can. Feel free to email us with any questions:

Phillyrescueangels@gmail.com

Philly Rescue Angels INC. reserves the right to reject any application based on information obtained during this screening process. Please understand that our primary goal is the health, happiness, and safety of our rescued dogs.

We are Registered, 501(c)3 Non-Profit Organization Focused on Animal Rescue and the Reduction of Animal Abuse.

PHILLY RESCUE ANGELS

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