Abbey Road Rescue Adoption Application

A 501(c)(3) nonprofit organization based in Little Rock, AR

abbeyroadrescue.org | 501.232.1845

ADOPTION APPLICATION

If this application is for a specific dog. what is name of the dog?

Name of Potential Pet Owner*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

E mail*

example@example.com

Date of Birth*

Date

If you've lived at this address less than two years, please provide previous address

Occupation & Employer Name*

Employer's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

How many adults, age 18 and over, live in the home?*

Please list all adults 18 years of age and older, who live in the home and provide their date of birth.*

List the ages of all children ages 17 and under, who live at this address full or part time.*

Does everybody who lives at this address want a dog? *

Do you*

OwnRent

Do you live in a*

HouseApartment / CondoMobile HomeOther

If you rent, please provide landlord name

First NameLast Name

Landlord Email Adddress

example@example.com

Landlord Phone Number

Please enter a valid phone number.

Do you have a fenced yard?*

YesNo

If you have a fenced yard, please describe (size of yard, type of fence, height of fence, etc.)

Where will the dog be kept at night?*

Where will the dog be kept during the day?*

If the dog will be kept outside at any time, please describe shelter available to the dog.

List all other pets you currently own by name, breed, sex, age and if they are steriized.*

Have these pets ever been around another dog?*

List all other pets that you have owned in the past 5 years and their age and why you no longer have them.*

Are your current dogs and/or cats current on recommended vaccinations and on flea/tick/ heartworm preventative?*

YesNoNot Sure

Are your current dogs and/or cats sterilized?*

YesNoNot Sure

If answered NO to the questions above, please use the space below to explain in detail.

Please Answer The Following Questions Completely

Why do you want to adopt a dog?*

How long will your dog be alone during the day while you are at work or away from home?*

Where will he or she stay during this time?*

Please describe how you will housebreak your dog if needed.*

How will you handle your dog's exercise needs?*

How often do you travel?*

Where will your dog stay when you are away from home?*

Have you ever surrendered an animal to an animal shelter? If yes, please explain why*

Dogs can live 16 years or longer. Do you understand that adopting a dog is a significant financial commitment (food, routine and emergency veterinary care, boarding, grooming, etc.)?*

Are you willing and financially able to make this commitment?*

Are you committed to keeping your dog and providing for him or her for the rest of his or her life?*

If you have other animals (especially dogs), what will you do if this dog does not get along with them? What if this dog is aggressive towards your other dogs or your other dogs are aggressive towards this one?*

How did you hear about Abbey Road Rescue?*

Please provide two personal references that we have your permission to contact. PLEASE notify them we will be contacting them and to please respond.

First Name Last Name Area Code Phone Number Email

First Name Last Name Area Code Email First Name Last Name Phone Number

Please provide the following information for the veterinarian you plan to use:

Name

Clinic Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Are you a current customer of this veterinarian? May we contact him or her?

If needed, please use this space for additional information you may wish Abbey Rescue Road to be aware of.

Abbey Road Canine Rescue dba Abbey Road Rescue [ARR] is a nonprofit organization whose purpose is to find homes for dogs in need to reduce to help reduce shelter overcrowding and euthanasia rates.

Abbey Road Rescue strives to ensure animals in our care are well cared for and treated compassionately.

It is the adopter's responsibility to immediate action to see that the animalis immunized and otherwise checked for their current health status.

The adopting person understands that it is very important that animals already in their home be in good health and be current on immunizations to reduce the risk of contracting an illness or disease from the adopted animal. The adopting person is advised to consult with their veterinarian regarding any recommended quarantine period prior to letting the adopted animal have any contact with other animals already in the home. The adopting person understands that most animals Abbey Road Rescue is attempting to place are from an unknown situation, and may have spent time homeless or in an animal control facility, and therefore may be fearful, nervous or have other characteristics that may be considered undesirable and the adopting person is prepared to work patiently with the adopted animal to overcome any such problems.

Abbey Road Rescue attempts to identify any animal which seems to demonstrate aggressive behavior. However, all pets can act in ways which are unexpected. ARR advises the adopting person to treat newly adopted animals with care and attention to see what type of characteristics they demonstrate. The adopting person understands that the temperament and disposition of any animal they adopt is completely unknown and not guaranteed at all. The adopting person assumes all responsibility for evaluating the animal and its suitability for their family.

Abbey Road Rescue makes no representations regarding the health or demeanor of any of the animals which it places for adoption and advises the adopting person to take all necessary care as their pet is adjusting to its new surroundings. The adopting person also agrees to indemnify and hold harmless Abbey Road Rescue for any act or conduct of the animal after delivery of the animal to the adopting person.

Please initial here to indicate that you have read, understand and agree with this disclaimer:

INITIALS*

Clear

I have read the above information carefully and have filled out this application honestly. understand that omission of information and/or failure to answer all questions honestly and completely can result in this application being denied.

If an omission or untruth is discovered after an adoption takes place, I understand that ARR reserves the right to annul the adoption and reclaim the animal. I give ARR permission to fully investigate the information provided including permission to contact references I have listed. If the application passes this review, I agree to a home and yard visit at a mutually agreed upon date and time by a ARR volunteer before an adoption decision is made.

I understand that the adoption decision is dependent on many factors, including but not limited to the compatibility of the family and home to the individual animal, and other applications received for this animal.

I understand it is ARR prerogative to decide which home is most appropriate and that their decision is final, and therefore I will not contest their decision.

Unless otherwise indicated by ARR, I will be free to apply and undergo the application process again in the future.

All adults age 18 and over living in the home must sign below.

I agree if for any reason that I cannot provide a safe and stable environment for this dog, I will immediately contact Abbey Road Rescue for guidance and possible assistance rehoming.

I agree that typing my name in the "Signature" space below and submitting this application to ARR, constitutes my agreement with all provisions of this application just as if I had actually signed my name.

Signature*

Clear

Signature

Clear

Signature

Clear

Date*

Date

SECTION BELOW IS FOR OFFICIAL USE ONLY BY STAFF OF ABBEY ROAD RESCUE

Date application received

Date

References checked by

Application reviewed by

Home visit conducted by

Date

Application Comments, including reason(s) for denial if appropriate:

Comments, including reason(s) for denial if appropriate