Country Acres Rescue- Adoption Application:
Contact Email: countryacresrescuesc@gmail.com
Thank you for your interest in adopting from County Acres Rescue. Our goal is to match each dog with the most suitable and loving forever home. Please complete this application as thoroughly and honestly as possible. The more details you provide, the better we can help you find and assure the right fit. All our adoptable dogs come up to date on vaccinations and are spayed or neutered. Unless specified otherwise. Submitting this Application does not guarantee approval or placement of a specific dog. Country Acres Rescue has the right to refuse any application for any reason. All information will be kept confidential and used solely for the purpose of evaluation protentional adopters. As part of the process, we may contact your references, veterinarian and landlord (if applicable) and conduct a background check or do a home visit. Once your application is received, a member of our team will review it and contact you with the next steps. We appreciate your interest in wanting to adopt a dog with Country Acres Rescue without people like you we could not continue the mission. We are committed to ensuring the best outcome for both our dogs and YOU!
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Understood.
This Adoption Application is for a:
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Dog
Please indicate if there is a certain dog(name) or the type of dog that you are looking to Adopt.
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Personal Information:
First and Last Name
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Date Of Birth
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E-mail:
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example@example.com
Cell Phone:
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Format: (000) 000-0000.
Street Address:
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City:
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State:
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Zip:
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How would you like to be contacted? Please note best way (e-mail, text, call) and the point of contact (phone number / e-mail)
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Do you have your own reliable means of transportation?
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Yes
No
Do you have a reliable source of income to be able to provide for the animal?
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Yes
No
Employer/Occupation
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How long have you been employed with your current employer?
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Please upload a photo of your driver's license or ID that clearly shows your name, date of birth and address.
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Emergency Name:
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Emergency Contact #:
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Format: (000) 000-0000.
Emergency Contact's Relationship
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Reference #1 Name:
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Reference #1 Phone Number
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Format: (000) 000-0000.
Reference #1 Relationship:
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Household Information:
Type of Dwelling:
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Home
Apartment/Condo
Townhome
If not a homeowner, do you have the landlord's permission to have a pet?
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Yes
No
I own my home/condo/apt/townhome
Please provide your landlord's contact information if you rent. If you own, please write the year your purchased.
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If you rent, do they have breed and/or weight restrictions?
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Do you have Children?
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Yes
No
Names of all persons living in your household, their relationship to you and their ages:
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Animal Experience and Personal Pets:
Do You have Pets?
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Yes
No
If yes, please list their species, breed, age and if they're spayed/neutered.
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Do you have experience with the breed you plan to adopt or have you researched the breed's typical personality traits and potential health issues?
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Work and General Information:
Where do you work from?
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Office
Work From Home
What is your work schedule outside the home (when are you gone):
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Will the dog be crated, restricted to a room or free-roaming?
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Crated
Restricted to a Room
Free-roaming
Outside
Will the dog live outside the house or inside the house?
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Indoors
Outdoors
Where would the pet be left when he/she is alone or when you are away from your home?
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Indoors
Outdoors
If Indoors:
Free Roaming
Crated
If outdoors:
Yard
Enclosed Patio/Sunroom
Garage
Dog Run
Other
If Other, Explain
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Fenced yard?
Yes
No
About how many hours will you be gone per DAY will the dog be left alone during the week?
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About how many hours will you be gone per DAY will the dog be left alone during the weekend?
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Adoption Questions:
Have you ever rehomed or surrendered a pet before?
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Yes
No
If yes, please describe the reason and how you surrendered or rehomed them?
Are all persons in the home over 18 in agreeance of getting the animal?
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Yes
No
Do you agree to allow the dog proper decompression time before introducing them to another dog? Minimum 3 days.
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Yes
No
Will you agree to continue the pet on rabies vaccinations and heartworm prevention medications?
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Yes
No
Depends
If you answered DEPENDS. Please state why,
Do you agree to a home visit prior to adoption?
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Yes
No
Please provide a vet that you have utilized in the last two years for us to contact as a reference. If you have not had a pet in that time frame, please indicate that.
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How do you plan to train/socialize your dog to help them adjust to your home and family? Please indicate if you plan to self-train, group train, private trainer or use another method.
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When you travel will your dog go with you? If not, what travel arrangements would you make to ensure that he/she is taken care of? Dog sitter? Boarding? Friend? Family Member?
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Tell us a little about your lifestyle so that we can help pair you with the right dog. Do you like to walk/jog/run, social activities, hike, couch potato or traveler, ect. ?
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If you were to move in the future for any reason, (job change, housing change, relocation, ect.) what steps would you take to ensure your adopted dog stays with you? Would there be any circumstances where you would consider rehoming them? Please explain.
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Why do you want to adopt a dog at this time in your Life?
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Is there anything you would like us to know that we haven't asked:
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Guidelines and Agreements:
I agree to indemnify, defend and hold harmless Country Acres Rescue and any of their employees or agents, from and against any and all losses, damages, costs, expenses including reasonable attorneys’ fees, obligations, duties, fines, penalties, interest charges or other liabilities including settlement amounts, paid or incurred as a result of any claims, demands, lawsuits, damages, actions, judgments or proceedings, which may occur to or be suffered by me, members of my household, or any third parties, by reason of activities arising out of this Agreement, including but not limited to, any liability caused by accident or other occurrence resulting in bodily injury, death, sickness or disease to any person(s) or damage or destruction to any property, real or personal, tangible or intangible.
Agree
I understand that although Country Acres Rescue takes reasonable care to screen animals before adoption, Country Acres Rescue makes no guarantees, claims, representations, or warranties, either express or implied, as to the health, behavior, temperament or actions of any animal(s). I hereby assume all risk of injury to myself, members of my household or any third parties, other pets, or damage or destruction to any property, real or personal, tangible or intangible.
Agree
Will you agree to contact Country Acres Rescue first prior to rehoming or surrendering the pet--if there becomes a need to rehome the animal? Country Acres Rescue takes back all of our dogs, they're family for life. If its not the right fit let us know.
Agree
I acknowledge that Country Acres Rescue is not liable for any veterinary expenses of the adopted animal(s) after the adoption is complete.Exception: In the case that the adopted dog is heartworm positive at the time of adoption, Country Acres Rescue agrees to cover the cost of the initial antibiotic and steroid medications, as well as provide six (6) months of heartworm preventatives for slow-kill treatment. Country Acres Rescue does not cover rapid-kill (adulticide) treatment, any additional medications beyond the initial treatment, retesting, or any veterinary care following the initial treatment period. All further costs are the responsibility of the adopter.
Agree
Do you agree to take your dog to their spay/neuter appointment if adopted dog is not yet spayed or neutered? Country Acres Rescue will follow up with you and the vet. Country Acres Rescue reserves the right to reclaim said dog if failure to spay/neuter.
Agree
I understand and agree that the adoption fee is non-refundable under any circumstances, including but not limited to changes in personal situation or return of the animal.
I agree
I agree to provide humane care, adequate shelter, and food to the dog I am adopting. I agree that I will be the primary caretaker of the adopted animal(s) and agree to ensure, and take full responsibility for, the health and well-being of the adopted animal(s). If it is found that said dog is not receiving adequate care and/or is being neglected, Country Acres Rescue reserves the right to reclaim said dog
Agree
I authorize Country Acres Rescue and its representatives to contact any references, landlords, and employers listed in this application for the purpose of verifying information, including employment.
I agree
Digital Signature:
By placing my full name and today's date in this box, I have read and fully understand this Agreement, Waiver and Release set forth above. I am eighteen (18) years of age or older. This document is binding upon me, my heirs, children, wards, personal representatives and anyone entitled to act on my behalf.
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