Pet Adoption Application Form

Adoption Application, Contract and Waiver

littlejranchcc@gmail.com

Perspective Pet Parent*

First NameLast Name

Name of Pet You Wish to Adopt*

Email Address*

Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Do you own any pets?*

Pet Name(s)

Pet Breed(s)

Pet's disposition and behavior towards other animals?

Please provide your veterinarian's name and phone number:

Do you own or rent your home?*

OwnRent

Do you have a fenced in area and shaded pen areas?*

YesNoI am working on thatOther

Do you have an adequate and clean water supply specific to the animal you plan on adopting?*

YesNoI am working on thatOther

If "Yes" how big is the pen? What kind of shade does it provide?

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?*

If you have to leave town, emergently or planned, who would care for your new pet?*

Please provide the names, emails, and contact numbers for 3 personal references:*

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 Little J Ranch adoption process, will undergo a homecheck, and interview at the discretion of Little J Ranch.
By clicking the submit button, I understand Little J Ranch 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 Little J Ranch and that it is tax deductible according to IRS 501(c)3 guidelines. I understand this donation will ensure the organization is equipped 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 Little J Ranch BY EMAIL and provide a 14 day period to allow Little J Ranch to make arrangents for my pet to be taken back into rescue.
By clicking the submit button, I agree to indemnify and hold harmless Little J Ranch 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 Little J Ranch 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, I understand that if I no longer want my pet, or am no longer able to care for my adopted pet, I will be directed to surrender my pet to Little J Ranch and provide transport to where Little J Ranch deems appropriate.
By clicking the submit button, I verify all of the above information is true and accurate.

Signature of Potential Pet Parent*

Date