406 K9 Rescue Adoption Application and Contract

Dog Adoption Application & Contract

406 K9 Rescue Foster to Adopt Application and Contract
Dog of Interest *
Name, description or preferences
Applicant Information
Applicant's Legal Name*
First and Last Name
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Street Address (Include City, State)*
Address where Dog will reside if different than mailing address
Phone Number*

Area CodePhone Number
Cell Phone or Alternate Phone Number

Area CodePhone Number
Applicant's Email*
How long have you lived at your current residence? *
If you have moved in the past 6 months, list last 3 previous addresses & length of residency below:
Street Address City State Length at residence Street Address City State Length at residence Street Address City State Length at Residence
Home and Household Information

Please verify with your Landlord or Homeowners Insurance Company that the breed you are interested in is permitted on property. Breeds such as pit bulls or bulldogs may not be.
Home Information (What type of home will the dog live in?)*

HouseMobile HomeCondo/TownhouseApartmentOther
Home Ownership Information (home ownership will be verified)*

I Own my HomeI Rent my HomeOther
Home Owner / Landlord's Name (If you are not the Home Owner)*
Note: If landlord does not approve the adoption of said animal, the adoption process will cease. Enter NA if you are the home owner.
Home Owner / Landlord's Phone and/or E-mail (If you are not the Home Owner)*
Failure to provide Landlord's contact information will result in your application being denied. Enter NA if you are the home owner.
The Home has the following (Please select all that apply):*

A Fenced Yard 4ft or tallerA Fenced Yard less than 4ft tallAn Outside KennelLocking gates on yard and/or a kennel doorA dog DoorNo Fenced YardNo YardOther
If there is no fenced yard how will you exercise the dog? *
If the yard is not fenced who will walk the dog and how often will you take the dog out? *
Please list below all the people in your household :
Name & Age (Self)*
List All household members below (Name, Age & Relationship)*
If child; Name is not required. Enter NA if you live alone.
What is your household's current activity level?*

Extremely ActiveActiveSomewhat ActiveNot VeryOther
Are there any members of your household who are allergic to dogs?*

YesNoPossibly
Are there any children that visit your home frequently?*

YesNoPossibly
Ages (if applicable)*

Non-ApplicableNewborn - 6 months6 months - 1 year1-2 years3-5 years5-10 years10-14 years14-17 years
For kids under 3 years old – how will you keep the dog separate from the children?*
Enter NA if no children under 3 years old.
Have your children been around animals?

YesNoNot Applicable - No children
General Care
Do you want this dog to be:*

Inside pet onlyOutside pet onlyBoth an Inside and Outside Pet (Depending on the weather)
Where will the dog be kept during the day when you are home? *
Example: Inside, outside in the yard, in a kennel outside, in a dog house, crated, etc.
Where will the dog be kept at night when you are home? *
Example: Inside, outside in the yard, in a kennel outside, in a dog house, crated, etc
How many hours during the average day will your dog be without a human?*
Where will the dog be kept when you are not home? *
Example: Inside, outside in the yard, in a kennel outside, in a dog house, crated, etc.
Do you plan on crate training? - if so, 406 K9 Rescue requires that the dog be kept in its own crate, large enough to stand up and turn around comfortably.*

YesNo
If you do not crate train, where will your dog be kept when you are away from the home and he/she is left alone? *
Enter NA if crate training.
The dog you are applying to adopt may have little to no inside home environment experience. What will you do if your new dog suffers from anxiety and whines or chews excessively? *
How will you handle potty training a dog that may not be fully house trained at time of adoption?*
** We cannot guarantee our dogs have ever lived in a home
Are you planning to move within the next 6 months?*

YesNo
What will happen to the dog if you move unexpectedly? *
What will happen to the dog if your new residence doesn't allow pets? *
What will happen to the dog if you go on vacation or in case of an emergency?*
What type of vehicle do you own? *
If you have a truck how will your dog be transported? *
Enter NA if not applicable.
Please tell us why you would like to adopt a dog:*
Emergency Contact Information (in case dog is found an you are unreachable)*
Emergency Contact Name and Phone
Household Pets

Verify pet limits with your local city ordinances. Many areas only allow 2 dogs per household.
Do you have any other pets living with you now?*

Yes (List Pets below)Yes and plan to adopt more beyond this pet (list Pets below)NoNo but plan to adopt more beyond this pet
Pet #1 (Dog, Cat, Bird, Etc)
Breed
Gender and Spayed/Neutered?
Age
Pet #2 (Dog, Cat, Bird, Etc)
Breed
Gender and Spayed/Neutered?
Age
List additional pets below (Breed, Gender and Spayed/Neutered & Age)*
Enter NA if Non Applicable
Has your dog(s) lived with other animals in the past?*

Yes (no issues)Yes (some issues)NoNo but has been socialized with other dogsOther
If your dog lived with other pets and had issues, please explain below*
Enter NA if Non applicable
If you have multiple dogs (more than 2) where will they all be when unsupervised ie when you are not home? *
Example: Free Range of home, outside in yard, crated, outside in kennel, etc. Enter NA if no multiple pets.
Have you owned pets in the past?*

YesNo
List Past Pets below (Type/Dog, Cat, Bird, Etc & Breed)*
Enter NA if Non Applicable
Where are your Past Pets now?*
Enter NA if Non Applicable
Have you ever surrendered an animal to a shelter or rescue? If so, please explain below:*
Enter NA if Non Applicable
Health & Behavior
Veterinary Name or Office*
Enter "None" if you do not have a regular Veterinarian.
Veterinary Phone and/or Email Address*
Enter "None" if you do not have a regular Veterinarian.
How often do you feel a dog should see a veterinarian? *
Do you feel you are financially capable of paying for routine veterinary care? (Est $100/year)*

YesNo
What will you feed your new dog? *
Example: Dry dog food, Raw meat diet, etc.
What kind of behavior do you find unacceptable that would deter you from keeping a dog? *
If the dog has problems with behavior what will you do about it? *
Would you euthanize a dog for Aggression towards other animals (dogs, cats, livestock)*

YesNoOther
Additional Information
Have you or anyone in the household been issued a warning or citation for an animal related offense (dog at large, barking or animal cruelty).*

YesNo
If yes, describe the situation and explain what was done to remedy the situation?*
Enter "NA if Non Applicable.
Are you currently on probation or parole?*

YesNoPending
If you are currently or will be on probation or parole, please list the officer's name and phone number and describe the circumstances below: *
Please check with your officer to ensure you are permitted dogs. Enter "NA if Non Applicable.
Additional Information for consideration (if any)*
Enter "NA if Non Applicable.
References

No Family or Household members
Reference #1 Name:*
Reference #1 Phone or Email: *
Cell Phone Prefered
Reference #1 Relationship to Applicant:*
Reference #2 Name:*
Reference #2 Phone or Email:*
Cell Phone Prefered
Reference #2 Relationship to Applicant:*
Adoption Contract/Terms of Acceptance

(Upon Adoption Approval and Transfer of Ownership)
Acknowledgment of Applicant/Signer*

✔I hereby agree to care for this dog humanely, (including providing adequate food, water, shelter and attention).,✔I agree that said dog shall be maintained in an adequate enclosed area or on leash at all times. Dog shall not be allowed to roam at will.,✔I agree to have dog neutered/spayed (if applicable).,✔I agree to have dog vaccinated annually with necessary inoculations (DHLP-P) and vaccinated against Rabies, as local ordinances requires.,✔I agree to provide the animal with necessary veterinary care upon sickness, disease orinjury and shall take it to a veterinarian at least once a year for an annual health examination androutine vaccinations.,✔Adopter will NOT LEAVE the dog UNATTENDED with a child under the age of 8 years alone for long periods of time.,✔The animal shall reside at the Adopter’s address.✔If said dog becomes lost or stolen, I agree to notify the 406 K9 Rescue immediately.,✔If, at any time, I am unable or unwilling to care for this dog, I agree to contact and return said dog to 406 K9 Rescue or a representative.,✔I agree not to sell, trade, dispose of or euthanize said dog (unless recommended by a veterinarian in the best interest of said dog),✔I acknowledge that the adoption fee (if applicable) will not be refunded after 10 days from adoption date.,✔I agree that the 406 K9 Rescue will keep 50% of the adoption fee if said dog is returned within 10days from the adoption date.,✔I agree that said dog shall not be used for medical or any other experimental purposes.,✔I agree that said dog will not be sold or given to a pet store, supplier or wholesaler.,✔I agree that said dog will not be used for any illegal purposes.,✔I agree that said dog will not be used for any type of breeding or animal fighting.,✔If applicable, certify that we do not live in a home or area where certain breeds are banned.,✔I agree to notify 406 K9 Rescue within 10 days of any change of address or phone number.,✔I understand that 406 K9 Rescue makes no guarantees or warranties regarding the health or temperament of this dog.
General Acknowledgement

(Upon Adoption Approval and Transfer of Ownership)
Acknowledgment of Applicant/Signer*

✔I have read and understand the above terms and conditions of adoption.✔I will keep the dog described herein as a family pet and not for the sole purpose of a guard dog.✔I understand that a dog going to a new home is stressful. Sometimes the animal can become scared or sick. It is up to the adopter to monitor to make sure he/she is acclimating well and if they do get sick will make a veterinary appointment to get started on appropriate medications.✔The Adopter agrees to give the described animal a minimum of two (2) weeks to acclimate to you and your household.✔The Adopter understands that the 406 K9 Rescue and its representatives have limited information regarding the health, temperament and/or habits of the animal. The Adopter agrees to accept the animal as described.✔The Adopter, does hereby release, discharge and hold harmless the 406 K9 Rescue, and any other person, firm or corporation charged or chargeable with liability, their heirs, administrators, executors, successors, and assigns from any and all claims, damages, costs, expenses, loss of services, actions and causes of action, whether known or unknown, belonging to the said Adopter arising out of any action or occurrence from the date of this contract in connection with the adoption of the animal described below.✔The 406 K9 Rescue may make inquiries and/or examine the animal at any time, upon reasonable notice. If the rescue determines the Adopter is not providing adequate food, shelter, veterinary care or is otherwise in breach of any obligations herein, the rescue shall be entitled reclamation of the animal and make arrangements for the animals care and re-adoption.✔The Adopter agrees to pay any and all expenses, including court costs and reasonable attorney fees in enforcing the terms and provisions of this contract.✔I understand Adoption Fees are non-refundable: Adoption fee includes the requirement of the spay or neuter within 4 months. Failure to have the animal altered will result in the termination of the adoption contract and forfeiture of the animal to 406 K9.A current vaccination/medical record of the adopted animal will be provided to you.✔I certify I am at least 18 years of age and the information provided is correct to the best of my knowledge. Providing false information will result in the reclamation of this animal. I am fully aware that I am adopting a living creature and the 406 K9 Rescue is unable to guarantee the health or behavior of the animal. I understand that I may return the animal to the 406 K9 Rescue if it has an illness diagnosed by a licensed veterinarian within 7 days of this adoption placement. I understand any sum paid to the 406 K9 Rescue is non-refundable except for the diagnosis of illness as stated above.✔I understand this is a binding contract, enforceable by civil law.✔I understand a breech of contract may result in confiscation of the dog and a fine ,punishable of up to $2500.00.
THE UNDERSIGNED hereby acknowledges they have read the terms of this contract and does hereby agree to abide by each of the rules of adoption set forth above. By signing below, I warrant the truthfulness of the information provided & certify that all information is true. I understand that false information may result in nullifying this adoption at any time. Electronic Signature*
Type Legal Name:
Date:
Should be Empty:

Dog Adoption Application & Contract

Applicant Information

Home and Household Information

Please list below all the people in your household :

General Care

Household Pets

Health & Behavior

Additional Information

References

Adoption Contract/Terms of Acceptance

General Acknowledgement