Pet Adoption Application Form

Adoption Application, Contract and Waiver

Perspective Pet Parent*

First NameLast Name

I certify I am over 21 years of age

Are All household members in agreement on adopting a pet.

Pet of interest*

I understand that the pet I am inquiring about will not be potty trained

YesNo

I understand if I answered NO to the above question then Almost Home is not the appropriate Pet Adoption resource for me.

Email Address*

Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Do you own any pets?*

If yes are, all pets current on vaccinations.

Pet Name(s)

Pet Breed(s)

Pet's disposition and behavior towards other dogs?

Please provide your veterinarian's name and phone number:

Have you given your Veterinarian permission to talk with us.

If you answered NO to the above question and you have Pets in the home your application will be denied.

Do you own or rent your home?*

OwnRent

Do you have a yard?*

YesNo

If "Yes" to the above, is it fenced? please describe

What is your landlord's pet policy?*

If you rent, please provide your landlord's information here:*

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

YesNo

Are there children in the home? (If yes, please list ages)*

If you answered "Yes" to the above question, please provide detail:

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?*

Do you have provisions in place for your pet if something were to happen (such as an emergency/illness, accident, have to move and can't bring them with you, or your pet outlives you)?*

YesNo

If you answered "Yes" to the above question, please provide a detailed description:

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 3 personal references:*

***REFERENCES CAN NOT LIVE IN THE SAME HOME****

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 Almost Home Rescue Inc. adoption process, will undergo a homecheck, and interview at the discretion of Almost Home Rescue Inc. By clicking the submit button, I understand Almost Home Rescue Inc. will check my references including veterinary and personal. By clicking the submit button, I understand there is an adoption donation associated with adoption of a pet from Almost Home Rescue Inc. and that it is tax deductible according to IRS 501(c)3 guidelines. I understand this donation will ensure the organization is equipped this to rescue another homeless pet. By clicking the submit button, I understand there is no "cooling off" period, and that if I no longer want or can no longer care for my adopted pet, I agree to notify Almost Home Rescue Inc. BY EMAIL. Almost Home is under no obligation to take your pet back. You understand that by adopting this pet you are committed to this pet for it's entire life. By clicking the submit button, I agree to indemnify and hold harmless Almost Home Rescue Inc. 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 Almost Home Rescue Inc. 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, By clicking the submit button, I verify all of the above information is true and accurate.

I am over eighteen (18) years of age.
I will not part with possession of the animal except to return it to the Almost Home Rescue, if for any reason I am unable to keep it. In the event that I fail to do so, I agree that I will be liable to pay to the almost Home Rescue all costs which they may incur in obtaining confirmation that the animal has been homed to a suitable person, with suitable premises. In the event that this is not the case, I also agree that I will be liable for all costs which Almost Home may incur, including all legal costs on an attorney and client scale, in recovering possession of the animal.
I will give the animal a fair chance to adjust to its new home.
I understand that donations are not refundable or transferable.
I will feed and house the animal to the Almost Home's satisfaction.
I will not chain or cage the animal, and understand that if it is found chained or caged, it will be removed from my care immediately.
I can afford the services of a private veterinary practitioner.
I will ensure that vaccinations are kept up to date and in the case of injury or illness professional veterinary treatment will be provided.
I will identify my dog with a collar and identification tag – o
My property is adequately enclosed and at no time shall I knowingly allow my dog to roam the streets.
I will notify theAlmost Home Rescue within forty-eight (48) hours should the animal die or go missing.
I know and understand the "By-Laws Pertaining to Dogs" of the Municipality in which I reside.
I will permit an authorized officer of the almost Home Rescue to visit my premises from time to time, to be assured that the animal is being treated in accordance with this Policy, and I will allow the almost Home Rescue to repossess the animal, if in the Almost Home Rescue opinion, the terms of this policy are not being reasonably adhered to.
I will not use or allow the animal to be used as a watchdog on any industrial or commercial premises.
I will notify the almost Home Rescue of any change of address in writing by registered post within seven (7) days.

I also agree that I will have my pet spayed or neutered and provide verfication to Almost Home Rescue. If I fail to do so Almost home reserves the right to recover my pet.

Signature of Potential Pet Parent*

This is a fill in the blanks field. Please add appropriate blank fields and text.