Adoption Application

Adoption Application
Please fill out ALL INQUIRIES to the best of your ability - incomplete applications will not be considered

All applicants must be 21 or older to adopt from Adopt-A-Dog. We will verify all information prior to approving an application. False information is cause for immediate rejection of an application. A veterinary reference is required. If you do not have pets currently, provide information for your most recent veterinarian. If this is your first pet, please tell us which veterinarian you plan on using. Two personal references are also required. Please answer questions thoroughly and with as much detail as possible. We want to know what a dog's life will be like in your home, so the more specifics the better! Should the dog you wish to adopt no longer be available for adoption at the time the application is fully processed, Adopt-A-Dog shall use all information contained herein for the sole purpose of matching the applicant with another dog or dogs for adoption without the need of preparing another adoption application.
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email *
example@example.com
Phone Number *
Please enter a valid phone number.
Alternate Phone Number *
Please enter a valid phone number.
Would you like to be added to the Adopt-A-Dog mailing list to receive updates about the shelter (typically once a month)?

Yes No
Applicant Date of Birth *

Month Day Year
Employer *
Job Title *
Please list all members of your household, including ages and occupations: *
Do you own your home or rent? *

Own Rent
Do you live in a: *

Single family home Duplex Townhouse Mobile home Condominium Apartment
If you rent, please provide the name and phone number of your landlord: *
Are there any restrictions or covenants where you live? *

Yes No
If yes, please list/explain: *
Pets I am Interested In
Please list the name and breed of the animal(s) you are interested in adopting. *
Please explain why you think this pet is a good fit for you: *
Why do you want to adopt a dog? *
What do you think are the most important responsibilities in owing a dog? *
Liability and Waivers:
1. I agree that Adopt-A-Dog shall not be held responsible for any liability for your pet once he/she has been adopted. *

Yes No
2. I agree that my pet will not be used in any illegal activities. *

Yes No
3. I agree that my pet will be kept as a house pet and will not be used for breeding, scientific purposes, or animal fighting. *

Yes No
Your Pet's Lifestyle
Who will be responsible for the care of your pet? *
How would you describe the activity level in your household? *
Where will your pet stay during the day/at night? *
Will anyone be home during the day? *

Yes No
How many hours will the dog be left unattended? *
Who will be responsible for feeding the dog and taking him/her outside? *
Are you willing to keep a collar with a tag bearing your name and phone number on your dog at all times? *

Yes No
What will you do with the dog when you travel? *
What will you do with the dog if you move/change housing? *
Will your pet have a dog walker/pet sitter? *
Are there areas of the home where your pet is not allowed? *
How will your pet exercise? *
Would you walk/exercise a dog on or off-leash, or both? *
Is your yard fenced in? If so, please describe what type of fence and the height. *
If not, why not? *
Have you ever bred dogs? *

Yes No
Do you plan on tail docking/ear cropping? *
Are you willing to take the time to work on housebreaking issues should the need arise? *

Yes No
Do you understand and accept that changing a dogs environment may cause the dog to have accidents, especially in the early days of the adoption? *

Yes No
The average life span of a dog is 12-15 years - are you willing to make a commitment to this dog for the rest of his/her life? *

Yes No
Would You Give Up Your Pet If…:
Please list any circumstance in which you would no longer keep your pet. *
Please explain what you would do if you could no longer keep your pet. *
Does anyone in your household have allergies to animals? *
If someone in your family develops allergies, what would you do? *
If, for any reason you are unable to keep your dog do you agree to notify Adopt-A-Dog immediately? *

Yes No
If you are unable to keep your dog, do you agree to return him/her to Adopt-A-Dog without hesitation?

Yes No
Are you prepared to pay for emergencies or accidents for your pet? *
How do you plan to train your pet? *
Would you consider obedience training for your pet? *

Yes No
If a behavioral problem arises, what steps will you take to work on it? *
Your Pet Experience:
Do you have other pets? If so, please list their breed and age: *
Are your current pets spayed/neutered? If not, please explain why: *
Have you had pets in the past? If so, please list their breeds and how long you had them: *
If you no longer have these pets, please explain why: *
Have you ever given away an animal for any reason? *

Yes No
What do you consider a good/valid reason for giving up a dog? *
References:
Please supply the name and phone number of your current or most recent veterinarian (be sure to indicate what name the pets medical records may be filed under): *
Please list TWO personal references including phone numbers - these should be people who know you especially with respect to your interaction with animals: *
Please list any concerns or final questions here:
I have read the above information carefully and have filled out this application honestly. I understand that omission of information and/or failure to answer all questions and sign the application can result in this application being declined. Also, if an omission or untruth is discovered after an adoption takes place, I understand and accept that Adopt-A-Dog has the right to annul the adoption and reclaim the dog.

I give Adopt-A-Dog permission to fully investigate the information provided as well as contact veterinarians and related officials. If the application passes this review, I agree to a home and yard visit on a mutually agreed date by an Adopt-A-Dog representative before an adoption decision is made.

Furthermore, I understand and accept that the adoption decision depends upon many factors, including – but not limited to – the compatibility of the family and home to the individual dog and other applications received on the dog. I understand and accept that Adopt-A-Dog will decide which home is most appropriate for the individual dog, and therefore I will not take issue with the decision. Unless otherwise indicated by Adopt-A-Dog, I may be considered for another dog.
Adoption Agreement

Adoption agreement – MUST be signed (electronic or actual signature)
This agreement is entered into this date by and between Adopt-A-Dog and the applicant (“Adopter”) for the adoption of the above identified rescue dog (“the dog”).

TERMS AND CONDITIONS

1. Adopter agrees the dog is to be a family companion and agrees to provide the dog with a safe home, adequate food, water, proper care, exercise, love and attention. Adopter agrees not to violate any federal, state, or local laws or ordinances with the dog. The dog is not to be used as an attack or protection trained dog and will not be used for commercial guard work.

2. Adopter agrees to keep a buckle collar on the dog with ID tag, current rabies tag and town dog license. The dog is only to have a choke collar on during training and walks. If at any time the dog is lost, stolen, hurt or killed, the Adopter is to notify Adopt-A-Dog immediately via writing.

3. Adopter agrees that the dog will be confined inside the home when no one is at home. When the Adopter is to go away for a prolonged period of time or vacation, Adopter is to pre-arrange proper care for the dog.

4. The dog is not to ride loose in the bed of pickup trucks, convertibles or to be left in a car when air temperatures exceed 65 degrees.

5. Adopter agrees to have a clean, secure fenced area for the dog. If a fenced enclosure is not available, Adopter agrees to leash walk dog. If Adopter uses invisible fencing, the dog is to be sufficiently trained before releasing it inside the system. Under no circumstances is the dog to be kept routinely on a runner or tie out.

6. Adopter agrees to have the dog examined by a licensed veterinarian at least once each year and provide for all vaccinations and treatments necessary to ensure good health. If euthanasia becomes necessary as determined by a licensed veterinarian, Adopter agrees to have it performed by such a licensed veterinarian. Adopter agrees to give monthly Heartworm, flea and tick preventative medication.

7. Adopter agrees to notify Adopt-A-Dog of change in address/phone number within two weeks of such change.

8. Adopt-A-Dog makes no guarantees or statements regarding the dog's age, breed, health, or temperament. While Adopt-A-Dog made every effort to provide accurate history and assessment of the dog, we are not able to guarantee the dog’s age, breed, medical status, behavior or disposition. No one can predict how any dog will react in a given situation, especially without complete knowledge of its background, as in the case with a rescued dog. The adopter(s) acknowledge this. Therefore, the adopter(s) are encouraged to exercise caution in introducing an adopted dog to new situations, family members, other pets, and visitors. The enthusiastic reactions of some children to dogs can often frighten the dog. It is strongly recommended that a responsible adult monitor the interaction between dogs and children at all times.

9. There have not been nor can there be made explicit or implied guarantees or warranties regarding the temperament, behavior or physical condition either of the adopted dog or of its freedom from genetic defects. The dog is adopted "as is" and the adopter(s) assumes all responsibility for treatment of any and all existing conditions or any other conditions, physical or temperamental, that may occur.

10. The adopter(s) hereby acknowledges, understands, promises and agrees to hold harmless and indemnify the rescuers from any and all claims, demands, actions, causes of actions, or liability of any kind whatsoever arising out of or in connection with this adoption/foster.

11. Please be advised that Adopt-A-Dog and its associates will be not be held responsible or liable for the actions of any dog when not in our immediate care and custody or when the Adopter takes physical possession of the dog(s). All dogs adopted and or fostered are the sole responsibility of the care provider signed below. By signing this document electronically or physically, the signer, which shall also include all family members, all residents, and all occupants who share the domicile and/or residence of the signer, understands and agrees to Hold Harmless “Adopt-A-Dog” and its associates from any and all Liabilities pertaining to the actions of the above mentioned dog. The below signed also acknowledges and accepts all the risks involved in the handling of this or any dog as “Adopt-A-Dog” specifically makes no representations or guarantees, express or implied, as to the lack thereof of the dog(s)’(s) violent propensities.

12. Adopt-A-Dog is available for consultation, advice and assistance pertaining to the health, training and compatibility of the dog. Adopter agrees to release Adopt-A-Dog and its members or representatives of any and all possible claims arising from injury or damage caused by the dog to any person or property. Adopter accepts this dog as is with all defects, either observable or unobservable, and assumes all risk for the dog upon signing of this contract.

13. If for whatever reason, including but not limited to: health reasons of the dog or Adopter, social reasons of the dog or Adopter, and issues of residency, the Adopter is unable to keep this dog for its entire life, the Adopter MUST return the dog to Adopt-A-Dog within 5 days of written demand to Adopter by Adopt-A-Dog. Furthermore, should Adopter wish to euthanize any dog for reasons due to health, sickness and/or age, prior to so doing, Adopter MUST first inform Adopt-A-Dog of same in writing. Should Adopt-A-Dog wish to obtain possession of the dog prior the euthanasia of same, Adopter must return the dog to Adopt-A-Dog within 5 days of written demand.

14. Adopter agrees not to give away, sell or dispose of the dog without express written consent of Adopt-A-Dog.

15. Adopter will allow Adopt-A-Dog to conduct home visits and phone check-ins at their discretion after adoption in order to check on the dog’s welfare up to 1 year after date of adoption.

16. Adopter agrees that puppies younger than 1 year will be enrolled in Obedience Training within 30 days of adoption.

17. In the event this contract, including all its covenants and conditions, is breached by Adopter, Adopt-A-Dog has the right to rescind this contract and demand return of the dog at any time. If Adopter fails to return the dog within 5 days of written demand to Adopter, Adopt-A-Dog will seek a Court Order for return of the dog and seek liquidated damages from the Adopter in the amount of at least $5,000.00 plus any court costs or attorney’s fees. Payment of damages shall not excuse Adopter from returning the dog to Adopt-A-Dog.

18. This agreement shall inure to the benefit of and be binding upon Adopter and Adopt-A-Dog and their successors or beneficiaries. Both parties have fully read and understood all of the agreement, which sets forth all promises, conditions, and understandings, oral or written.

19. Any disputes between the parties are to be resolved in a court of law in the State of New York venued in Westchester County and shall be resolved in accordance with the laws of the State of New York. 20. By emailing this adoption contract on behalf of any dog in Adopt-A-Dog’s care, adoptee’s electronic submission/signature is considered binding.
Signature *

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Adoption Application

Please fill out ALL INQUIRIES to the best of your ability - incomplete applications will not be considered

Pets I am Interested In

Liability and Waivers:

Your Pet's Lifestyle

Would You Give Up Your Pet If…:

Your Pet Experience:

References:

Adoption Agreement