Pet Adoption Application Form

Adoption Application, Contract and Waiver

Prospective Pet Parent*

First NameLast Name

Name of Pet You Wish to Adopt*

Email Address*

Your Birthdate*

Birthdate

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) and ages(s)*

Pet Breed(s)*

Pet's disposition and behavior towards other dogs?*

Please provide your VETERINARIAN's NAME and PHONE NUMBER we will call them to make sure your pets are up to date on vaccines and HEARTWORM prevention. This is a non negotiable: PLEASE DON'T FORGET YOUR VET'S PHONE NUMBER*

Do you have a yard?*

YesNo

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

Do you own or rent your home?*

OwnRent

If you rent, please provide your landlord's contact information as well as their Pet Policy here:*

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

YesNo

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

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

Where will the pet spend most of the time and where will he/she sleep?*

How many hours per day would the pet be alone?*

Will you crate your dog?*

How will you provide adequate exercise for your dog?*

Do you agree to keep your dog up to date on vet recommended vaccines and heartworm prevention *

If you have to leave town, emergently or planned, where would your dog/other pets stay?*

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, and contact info for 3 personal references:*

"If you or your family were to suffer a catastrophic financial or physical event that rendered you unable to house or care for your dog/dogs; who would care for them and where would they live?" Please Be Specific. Have you discussed a plan with family members or friends?*

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 Rusty's Legacy adoption process, will undergo a homecheck, and interview at the discretion of Rusty's Legacy
By clicking the submit button, I understand Rusty's Legacy 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 Rusty's Legacy 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 Rusty's Legacy BY EMAIL and provide a 14 day period to allow Rusty's Legacy to make arrangents for my pet to be taken back into rescue.
By clicking the submit button, I agree to indemnify and hold harmless Rusty's Legacy 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 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 Rusty's Legacy and provide transport to where Rusty's Legacy deems appropriate.
By clicking the submit button, I verify all of the above information is true and accurate.

Signature of Potential Pet Parent*