Lynn for the Animals Adoption Application

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number (Mobile)*

Phone Number (Work)*

Phone Number (Home)*

E-mail*

example@example.com

Are all members of the household want to adopt a dog?

Anyone allergic to animals?

Do you have children? If so, please list ages:

What dog are you interested in?

Do you have another pet?*

YesNo

Is your pet used to other pets?

YesNoOther

Where is it (are they) now?

What pets do you currently have? Breed, age, sex, spay/neuter?

I / We live in a*

Please list landlords contact information:

Do you have a fenced in yard?*

YesNo

What type of fence?

How high is your fence?*

Where does the pet stay (be confined) while you are out?*

Where will the dog be kept during the day? *

Do you have a regular veterinarian?*

YesNo

Veterinarian’s name*

Clinic Name*

Clinic's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Clinic's Telephone*

Number of hours (average) pet(s) spends alone*

Please add at least two references*

Do you agree to spay/neuter the dog you adopt within four (4) months if necessary?

I hereby cerfity that all provided information is true to the best of my knowledge. I understand that a member of rescue will conduct vet references, home visit in person or virtual and personal interview.

Applicant Name:

Signature

Date:

Release of Waiver Form

Applicant Name:

I hereby, for myself, my heirs and my personal representatives, represent and warrant as follows:

- I am fully aaware the risks that dogs pose and have elected to view and/or interact with one ormore dogs in the care of Lynn for the Animals Rescue voluntarily. I knowingly assume all risks that exposure to dogs my pose including but not limited to, serious bodily injury and/or death.

- I hereby waived release and discharge, hold harmless and promise to indemnify and not bring suit against the rescue, officers, volunteers, staff adn all other agents and parties, or on behalf of any of the referenced parties from any and all rights and claims which I have or which may accrue to me and from any and all damages which may be sustained by me directly or indirectly in connection with, or arising out of, my exposure to such dogs.

Yes I accept this waiver and release Lynn for the Animals Rescue from all liability.

Signature

Date:

LYNN FOR THE ANIMALS ADOPTION APPLICATION

Applicant Details

Release of Waiver Form