Rescue Dog Adoption Application

Deep South Dog Rescue is a volunteer based, non-profit, animal welfare organization dedicated to the rescue and placement of stray, neglected and abused animals. Deep South Dog Rescue is completely funded through fundraising efforts and public donations. All of our pets are cared for by foster homes and receive complete medical care, which includes worming, vaccinations, spaying/neutering and microchipping prior to their adoption.

This questionnaire is designed to help Deep South Dog Rescue and yourself determine if a specific dog is the right one for you and your household. All adopting parties are required to complete this form prior to adoption. Deep South Dog Rescue reserves the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoptions! All dogs in the home must be spayed/neutered, and must be actively on heartworm prevention and up to date on vaccinations. These are basic requirements to adopt any animal from Deep South Dog Rescue. A vet reference is REQUIRED to adopt.

Name of the dog you are interested in:*

Your full name:*

Your age:*

Street Address:*

City, State, Zip*

Cell Phone:*

Area CodePhone Number

E-mail:

Employer:

Character reference and phone number:

Are all members of your household in agreement with this adoption?*

YesNoDon't Know

Do you live in a*

Who will be the pet's primary caregiver?*

Do you own or rent?*

OwnRent

If rent, provide name and phone number of landlord:

Does your landlord allow dogs?*

YesNoOther

Are there any restrictions from your landlord or subdivision?*

Number of petsSize or weight restrictionsBreed restrictionsNone

Do you have a fully fenced yard?*

YesNo

Height and type of fence?*

Do you have any of the following?*

Underground fenceKennelDog Run

How many adults are in your household?*

How many children are in your household?*

If children, what are their ages?*

Have your children been around animals before?

YesNo

Does anyone in your home have allergies to dogs or have asthma?*

YesNo

List any pets you own or have owned in the past five years, and their ages*

How many of these pets are spayed/neutered?*

What kind of heartworm prevention do you use?

If your pet is not spayed or neutered, please provide a medical reason and documentation to prove this procedure is not necessary.

Where are these animals now?*

Have you adopted from an animal welfare group before?*

YesNo

If yes, what group?

Have you ever given up a pet?*

YesNo

If yes, what were the circumstances?

Please provide the name and phone number of your current and/or previous veterinarian or clinic. By providing this information, you are giving consent for a vet reference check:

What type of personality do you want your pet to have? (i.e. calm, energetic, protective, couch-potato)*

Are you aware of crate training?*

YesNo

Have you ever house-broken a dog or puppy before?*

YesNo

If the dog has an "accident" in your home, what type of correction do you plan to use?*

How many hours each day will your new pet be home alone?*

Where will your new pet sleep at night?*

How will you supervise the dog's outdoor activity?*

Where will your new dog stay when nobody is home?*

What length of time will you allow your new pet to adjust to his new home?*

Are you willing to work through your new pet's issues, if any?*

YesNo

Are you aware that a new environment is stressful for your pet, and they may exhibit uncharacteristic behavior?*

YesNo

Do you understand that a dog can be an 18 year commitment, and can cost $500-$1000 per year to care for?*

YesNo

Do you plan to take an obedience class with your dog?*

YesNoNot sure

If yes, where?

Are you aware that a large breed dog takes about two years to mature? Is this something you're prepared for?*

YesNo

What circumstances would lead you to give up your new dog?*

If you had to give up your dog, what would you do with him/her?*

How did you find out about Deep South Dog Rescue?*

I understand that I assume full responsibility for the welfare of this pet from the date of adoption.

AGREE TO ADOPT

included cost of spay/neuter, microchip, heart worm test (if dogs over 6 months upon intake), inital fecal test & dewormer, heartworm prevention until adopted, vaccines and examination by licensed veterinarian, and any other services completed prior to adoption. If any of the services listed above have not been completed by the time of adoption, they must be scheduled and completed at an approved and participating Deep South Dog Rescue veterinary facility.

Please consider making an extra donation to help cover the cost of medical expenses for the many sick and injured dogs taken in by the rescue.

All original medical records will be transferred to adopter. It is adopter's responsibility to maintain these records in a secure place for future reference.

Should all records not be availbe at the time of adoption, the rescue will promptly mail to adopter once recieved.

If during anytime within the dogs life that you need to return the dog the dog promptly has to be retuned to Deep South Dog Rescue with all vet information, and rabies tag.

PLEASE READ CAREFULLY TO UNDERSTAND WHAT YOU ARE AGREEING TO!

By entering his/her signature below, the ADOPTER hereby agrees to the following terms and conditions:

1. On the effective date of this adoption agreement, adopter assumes complete & total liability for the adopted dog. I agree to hold Deep South Dog Rescue and its board members, harmless for any financial, medical, or legal liability associated with the dog.

2. Adopter acknowledges that Deep South Dog Rescue is providing an animal for adoption on as "as is" basis. Deep South Dog Rescue cannot guarantee breed mix or age, and is providing it's best estimate based on experience and veterinatian estimation. Deep South Dog Rescue makes no representation as to the temperment or medical condition of the dog being adopted. All medical records recieved by Deep South Dog Rescue are provided to the adopter.

3. If adopter chooses to have the animal checked by their own licensed veterinatian, it is at their own cost. Any medical issues which may be present shall be brought to the attention of Deep South Dog Rescue within 30 days of adoption, who may, at its own discrestion, assist in the treatment process. Upon request, adopter will provide Deep South Dog Rescue with proof of the required vet visit.

4. Adopter shall allow a representative of Deep South Dog Rescue to visit/check on the dog on a random basis during the first year of adoption & to notify Deep South Dog Rescue of any change of address during this time period. Should Deep South Dog Rescue find that the dog is not being cared for in compliance with this agreement, or in violation of local or state laws, Deep South Dog Rescue reseves the right to seize the dog for the safety & welfare of the dog.

5. Adopter shall provide for the dog's physical and emotional needs including: proper diet & nutrition, housing, exercise, medical care, vaccinations, & monthly heartworm preventative for the remainder of its natural life.

6. Adopter shall comply with all state and local laws pertaining to the care and keeping of the dog, including leash laws, licensing, registration and rabies vaccinations.

7. Adopter agrees that the dog will be kept as an inside dog, and be taken outside only with supervision for exercise, play and potty needs.

8. Adopter agrees not to abandon, give away, sell or trade the dog for the duration of the dogs natural life. Adopter agrees to contact Deep South Dog Rescue in the event that the dog cannot be kept due to unforeseeable circumstances in the future. Should re-homing be necessary, it must be done in conjunction with the rescue. Under no circumstances will the dog be sold, returned to any other adoption event facility, surrendered to a shelter or other rescue group. If the adopter/dog does not live local to Deep South Dog Rescue the adopter must pay for the cost of transport the dog back to the rescue.

9. Adopter agrees to make every reasonable effort to locate the dog should it escape or become lost, or stolen, including contacting Deep South Dog Rescue as soon as possible. Deep South Dog Rescue will provide information and/or assitance to help relocate the missing dog.

10.It is a requirement of this rescue that ALL animals adopted be spayed or neutered by 6 months of age. If you have adopted a puppy too young for this procedure, you will be required to have this done at an approved and participating Deep South Dog Rescue veterinary facililty. If the adult dog you have adopted has a scheduled spay/neuter appointment, you are required to honor this appointment. If an appointment has not been scheuled or has not been done due to the health of the dog, you will have 45 days after the adoption to have this procedure done at one of the rescue's approved clinics. Should the animal not be altered prior to this date, you are in violation of this contract and the rescue will take the necessary steps to reclaim the dog.

11. Adoptions fees are $150-$350. Adult adoption fees include vaccine, fecal, deworming, spay/neuter, microchip, and rabies. Puppy adoption fee include puppy vaccines, microchip, spay/neuter, fecal, deworming, and rabies.

12. Puppies require a series of booster shots spaced 3 weeks apart. This is included in your adoption fee. During the 1st round of shots, we will also do an initial fecal test and deworming. All subsequent fecal tests and deworming medication, if needed, are the responsibility of the adopter. Should the adopter choose to have the remaining shots at another veterinary clinic other than the one approved by the rescue, payment responsilibity is that of the adopter. Adopter must submit proof to Deep South Dog Rescue that this service was performed within the proper timeline. By signing I understand what services are included in the adoption fee and that the cost of any other services or medication is my responsibilty.

13. If all included services have already been completed at the rescue's veterinarian, I must make a visit to my veterinarian within the first 30 days of adoption. If i currenlt do not have a veterinarian, I understand that I must establish one, bring the dog to its first appointment, and contact the rescue with the name & phone number of my new veterinarian within this time frame.

14. If i return the dog for any reason, whether at my request or the request of ths rescue, I understand that I must return the dog, along with the vet information packet and rabies tag (if provided).

15. If Deep South Dog Rescue discovers any detrimental or false information recieved regarding the welfare of this animal or if we feel the placement is incorrect at any time, Deep South Dog Rescue reserves the right to reclaim the animal. Should this occur, I agree to promptly return the animal to the rescue within 24 hours of notification.

16. I understand the adoption fees are fully earned by the rescue & non-refundable for any reason.

17. Should adopter pay with a check and the check is returned for insufficient funds or any reason, the adopter agrees to immediately replace with cash, money order, venmo, or paypal, including a $30 NSF fee.

18. If Deep South Dog Rescue deems it necessary to use an attorney to enforce the terms of this agreement, adopter shall be responsible for the payment of the attorney fee's, court costs, and/or fines necessary to enforce this agreement.

19. Arrangements must be made by the Adopter to get their dog. If the Adopter lives a distance that they are not willing to travel all expenses of tranport are the responsibility of the Adopter. The health certificate will be paid for by Deep South Dog Rescue. All other equipment (leashes, collars, harness, etc) must be purchased by the Adopter. It is the responsibility of the Adopter to either: mail the equipment to Deep South Dog Rescue or send money for the equipment so a Deep South Dog Rescue representative can purchase.

20. Unless otherwise discussed with adopter, once the adoption fee has been paid to Deep South Dog Rescue the adopter has 3 days to get their adopted dog. After the 3 days there will be a $10 a day boarding fee added, if arrangements have not been to made after 2 weeks (14 days) of receiving the adoption fee the dog will go back up for adoption. The adoption fee or boarding fee is non-refundable.

I, the undersigned adopter, having read and acknowledged the terms and conditions of this agreement,understand i will recieve a copy of the terms, agreement and all medical records availble for the animal I have chosen to adopt.

Effective upon the date on contract, I, the adopter, assume complete liability for the animal and agree to hold Deep South Dog Rescue and its board members, harmless for any financial, medical, or legal liability associated with the animal

I agree to abide by all the conditions listed within this agreement and to maintain contact with Deep South Dog Rescue during the first year of adoption to help ensure a smooth transistion of this dog to my family.

I certify that the information provided on this application is complete, true and accurate to the best of my knowledge. I understand that providing false information may void this application and result in forfeiture of the adopted animal, as well as any adoption fees paid.

Applicant Signature & Date

Deep South Dogs Rescue Adoption Application

Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information