A PLACE OF HOPE SMALL DOG RESCUE ADOPTION APPLICATION

Adoption Application/Agreement

This is a legally binding contract.

APOH Rescue reserves the right to refuse to adopt a pet with no explanation.

Date*

Date

Dogs Name *

Breed *

Physical Description *

Dogs age*

What are you looking for in a pet? *

Adopter's Name*

First Name Last Name

Spouse / Partners Name*

First Name Last Name

Adopters Date of Birth*

Date

Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Adopter's Age*

Phone Number*

Secondary Phone Number

Email*

example@example.com

Do you:*

OwnRentOther

What type of housing do you live in?*

Single Family homeApt or CondoTownhouseOther

If renting please provide landlord name and phone number so that we can confirm pets are allowed.

Landlord's Name

First Name Last Name

Landlord's Phone Number

Please enter a valid phone number.

Do you have an inground pool*

YesNo

If yes, is it enclosed or fenced off so that there is no pet access?*

YesNoNA

Do you have children that live in your home?*

YesNo

Please list the name and age of every person that lives in your home:*

If you have children that live in your home, please describe their typical interaction with dogs

Do you have children that visit your home often?*

YesNo

If yes, what are their ages?

If yes, please describe their typical interaction with dogs

Do you have a fenced in yard:*

YesNoPartially fenced

If you have a fenced yard, choose the type:*

If other please explain:

Do you use a dog door?*

YesNo

Current Pet Information and history:

This is required to adopt from us and will be verified with your vet.

Number of dogs*

Please list the name, age, breed and weight of each dog*

Number of cats*

Number of other*

Veterinarian or Clinic Name*

Veterinarians Phone #*

What name will the vet have the records under?*

Are all of your animals spayed/neutered*

YesNoNA

Are they up to date on Rabies and DHPPV?*

YesNoNA

Are they on Heartworm prevention?*

YesNoNA

I use * as my brand of heartworm prevention .

Are they on Flea prevention?*

YesNoNA

Will your dog welcome a small dog?*

Where will your dog stay?*

InsideOutsideInside and outside using a dog door

Where will your dog stay when you are not at home?*

Where will your dog sleep at night?*

Will your dog be crated?*

YesNo

If yes to crating -- Day time hours

If yes to crating -- Night time hours

Have you ever given up a pet?*

YesNo

If yes, please explain the circumstance:

Have you lost a dog to injury or illness in the past?*

YesNo

If yes, please explain what happened:

If you currently have no pets:

Have you owned a pet in the past 10 years?*

YesNo

If yes, please complete the information in this section.

Previous Pets name

Previous Veterinarian or Clinic Name

Phone #

What name will the vet have the records under?

What happened to this pet?

TERMS OF ADOPTION

By choosing "yes" on the following items I understand and agree to the terms of adoption:

IF YOU ADOPT ONE OF OUR DOGS, YOU AGREE TO A HOME VISIT DONE BY ONE OF OUR VOLUNTEERS EITHER BEFORE OR AFTER THE ADOPTION. A NEGATIVE HOME VISIT WILL NULL AND VOID THE ADOPTION CONTRACT. IF THE HOME IS NOT FOUND TO BE A SAFE AND HEALTHY ENVIROMENT FOR THE DOG YOU AGREE TO LET THE VOLUNTEER CONDUCTING THE HOME VISIT TAKE THE DOG AND RETURN IT TO APOH RESCUE AT THAT TIME. IF IT IS DETERMINED THAT THE DOG NEEDS TO BE RETURNED TO THE RESCUE A FULL REFUND OF THE ADOPTION FEE WILL BE ISSUED BY CHECK WITHIN 10 BUSINESS DAYS.*

YesNo

IF YOU ARE ADOPTING A DOG THAT IS WAITING FOR A SPAY/NEUTER: IT IS REQUIRED THAT YOU GET YOUR NEW FAMILY MEMBER TO THE APPOINTMENT THAT IS PROVIDED TO YOU. IF YOU ARE UNABLE TO MAKE IT TO THE APPOINTMENT YOU MUST GIVE AT LEAST 48 HOURS NOTICE FOR US TO RESCHEDULE YOUR APPOINTMENT. CALL 850-503-0469 TO NOTIFY US. LEAVE A VOICEMAIL IF NO ANSWER OR LEAVE A TEXT MESSAGE. A MISSED APPOINTMENT WITHOUT NOTICE FORFEITS THE RESCUE PAYING FOR THE SPAY/NEUTER. THEN THE SPAY/NEUTER WILL BE AT THE ADOPTERS EXPENSE AND IS REQUIRED WITHIN ONE MONTH OF THE ORIGINAL DATE OF YOUR MISSED APPOINTMENT OR YOU AGREE TO RETURN THE DOG TO THE RESCUE.*

YesNo

If you adopt one of our dogs, you agree NEVER to rehome the dog, and to return him/her to APOH Rescue if for any reason you are unable to keep him/ her.*

YesNo

If you adopt one of our dogs, you agree to give APOH Rescue complete access to the dog's records with the veterinarian responsible for the care of the dog.*

YesNo

If adopting an unaltered puppy, the adopter agrees to have the pet spayed/neutered by 6 months of age by our vet. Failure to have the spay/ neuter done by 7 months of age will result in forfeiture of the pet. The pet will be returned to APOH Rescue. No refund will be given if the pet is returned to APOH Rescue due to failure to adhere to the spay/neuter policy.*

YesNo

Pet will be altered at one of our veterinarian's offices at APOH Rescue's cost or at the adopter's vet at their own cost.*

YesNo

If your new dog shows signs of illness in the first 3 days please call 850-503-0469 or 850-232-3338. If it is something that requires a vet visit, we will make you an appointment at our vet and we will cover the cost. If you take the dog to your personal vet we will not be responsible for the vet bill.*

YesNo

The fee covers the vet care and is what helps the Rescue to continue to save dogs. This includes vaccinations, a microchip with a life time registration, Proheart 12 Injection for a full years heartworm protection (if one year or older) spay/neuter and any health issues that the dog was treated for. All dogs over 6 months of age have been tested and are heartworm negative OR are being treated by APOH Rescue.*

YesNo

Do you agree to continue these treatments for your pet's lifetime?*

YesNo

The pet will be microchipped with a lifetime registration that is covered by APOH. The microchip is non transferrable and will stay with APOH as the primary contact. You will be listed as the "adopter" and need to keep your contact information current with APOH if something changes.*

YesNo

If for any reason you are not satisfied with your rescue dog, the adoption fee is refundable minus a $50 fee, if returned within the first 10 days. If you would like to try a different dog there is no fee, but you will be required to pay any difference in the adoption fee.*

YesNo

The adoption fee is non-refundable after the 10 day adjustment period.*

YesNo

If a refund is being issued: A check will be issued to you within 14 business days of the date of the return of the dog.*

YesNo

The adoption fee may be paid by cash, local checks with valid ID, PayPal, Venmo, credit card (a 3.5% fee is added for credit card payment) or money order.*

YesNo

Adoption fees start at $250.00 and go up. Each dog may have a different fee. These fees are subject to change without notice. This fee is set by the board and is what helps the rescue save your rescue dog and many more rescue dogs in the future.*

YesNo

We only adopt to owners we feel are suitable. Small breed dogs cannot live outdoors or be left alone for more than a normal work day (8 hours). They may require dental exams yearly along with regular physical exams. If you are approved for adoption, you agree that all veterinary care will be provided as recommended by your veterinarian.*

YesNo

Date*

Date

Your Signature means that you agree to the terms in this Adoption Contract. Adopter's signature*

Clear