Hidden Gem Animal Rescue Adoption Application

Name

First NameLast Name

Date

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Email

example@example.com

What is the name of the dog that you are applying to adopt?

Are you adopting a dog:

for your homefor someone elsefor your workplace

List the members and ages of the people in your household.

Do all household members want to adopt a dog?

YesNo

Is anyone in the household allergic?

YesNo

Briefly describe your residence:

How long have you lived there?

Do you:

OwnRentSublet

On what floor do you live?

If you rent, does your building allow pets? (we will need to see proof that pets are allowed)

YesNoN/A

Do you have a:

If you have a yard, please describe it (fenced/unfenced, size, height of fence etc)

Will you travel with your dog? If so, where?

How many hours will your dog be alone each day?

Where will your dog spend most of his/her day when you are home?

Where will your dog spend most of his/her day when you are away?

Employer

Occupation

Work schedule

How long have you worked there?

Does your job require travel?

YesNo

Does your budget allow for the cost of maintaining a pet, and can you cope with veterinary expenses?

YesNo

Have you had dogs or other pets in the past? If so, please describe what kinds of pets you had, where they came from and where they are now, etc.

Do you have other pets now? (name(s)/species/age/breed/sex)

Are your pets:

neuteredvaccinatedN/A

What kind of dog do you wish to adopt? (Age range, color, sex, short/long hair, disposition)

Please list the name and phone number of the veterinary clinic that you have/will use. If you currently have, or recently had, pets we will ask for a vet reference.

Please list three references (friend, family member, or colleague).

	Relationship to you	Phone number	Email
Reference 1
Reference 2
Reference 3

What kind of food do you prefer to feed? (wet, dry, brands)?

How would you manage any behavioral issues you might experience with your dog?

A dog can live to be 16 or older. Do you believe you will be able to keep your dog for its full life span?

YesNo

Have you ever had to re home/surrender a pet? If so, why?

What provisions will you make for the dog's future, in the event that you can no longer care for it?

If for any reason you cannot keep one of our babies, you must agree to contact us, give us a little time to move them and not give them away to anyone else. We have the right to take back our dog and make arrangements on their behalf. Do you agree?

Yes, I agreeNo, I do not agree

Signature

By clicking the submit button, I acknowledge that the above information is true.

By clicking the submit button, I have acknowledged and agreed to the following terms: In filling out this form, the adoption of this animal is not guaranteed to me. Due to the unpredictability of an animal’s behavior, Hidden Gem Animal Rescue will not be liable for any destruction or injuries sustained from our animals. Hidden Gem Animal Rescue is a non profit organization that works with many veterinary organizations but are not medically qualified themselves and will not be held liable for any unknown medical conditions that may occur. Adopting and interacting with animals from rescues, such as Hidden Gem Animal Rescue, comes with its own personal risks such as injuries, property damage, financial costs, and medical conditions; I have acknowledged that Hidden Gem Animal Rescue will not be held liable for these risks. Any adoption fees paid toward Hidden Gem Animal Rescue are nonrefundable, yet if the owner becomes incapable or unable to provide and care for their animal, they are to be returned to Hidden Gem Animal Rescue. I am financially capable of taking on this animal and will take the adopted animal to a veterinary service approved by Hidden Gem Animal Rescue. I have enough time to both care for the animal and spend quality time with them. I will do my best to keep in contact with Hidden Gem Animal Rescue and will provide the best care I can for the animal I am adopting. If there is ever a medical or general emergency, euthanization, or relocation of the animal, Hidden Gem Animal Rescue is to be contacted immediately. If/once I adopt the animal I must pay its set fee within 30 days. If the animal is being abused, neglected, or mistreated, Hidden Gem Animal Rescue has the right to reclaim the animal.

Thank you for your application and consideration.

Hidden Gem Animal Rescue (Dog)