Rescue Dog Adoption Application

Akira Animal Rescue is an all-volunteer, non-profit, animal welfare organization dedicated to the rescue, rehabilitation and placement of high-risk dogs - particularly those facing euthanasia in overcrowded shelters due to medical needs, behavioral decline, or breed discrimination. We provide individualized care, trauma-informed training, and loving foster environments to help each dog heal and thrive. Our ultimate goal is to place every dog into a safe, stable, forever home.

Akira Animal Rescue is completely funded through fundraising efforts and public donations. Majority of our pets are cared for by foster homes and receive complete medical care, which includes worming, vaccinations, spaying/neutering, surgery (if needed) and microchipping prior to their adoption.

Name of the dog you are interested in:*

Your full name:*

Your age:*

Street Address:*

City, State, Zip*

Home Phone:

Area CodePhone Number

Work Phone:

Area CodePhone Number

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 own or rent?*

OwnRent

Does your landlord allow dogs?

YesNo

How many adults are in your household?*

Adults 18+

How many children are in your household?*

If children, what are their ages?

Do you have any pets?*

YesNo

Please list your current pets. Include their name, species, and gender:

If you have pets, are you willing to follow the rescues instructions for proper integration, including purchasing an indoor gate for separation?

YesNo

Please provide the name and phone number of your current and/or previous veterinarian or clinic:

Here are a few essentials that will make your pup feel at home:

How did you find out about Akira Animal Rescue?

By signing this form, I agree to Akira Animal Rescue adoption process, will undergo a homecheck, and interview at the discretion of Akira Animal Rescue
By signing this form, I understand Akira Animal Rescue may request references at any point in the adoption process.
By signing this form, I understand there is an adoption donation associated with adoption of a pet from Akira Animal Rescue 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 signing this form, 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 Akira Animal Rescue BY EMAIL and provide a 14 day period to allow Akira Animal Rescue to make arrangents for my pet to be taken back into rescue.
By signing this form, I understand that Akira Animal Rescue will disclose any of the pet's health or behavior issues known by the above named rescue group before adoption is completed.
By signing this form, 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 Akira Animal Rescue and provide transport to where Akira Animal Rescue deems appropriate.
By signing this form, I agree to indemnify and hold harmless Akira Animal Rescue 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 signing this form, I verify all of the above information is true and accurate.

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

Signature

Date

Akira Animal Rescue Dog Adoption Application

Applicant Information

Household Information

Adoption Checklist