Little Bink Rescue Adoption Application

Veterinarian Information
Do you have a regular Veterinarian?
Veterinary Clinic's name:
Veterinary Clinic's phone number:
Street Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
About the Dog You Wish to Adopt
Why do you wish to adopt a dog?
Are you financially able to care for a dog?
Where will the dog spend most of the day?
Where will the dog sleep at night?
How long will the dog be alone each day, on average?
Describe your ideal dog:
Which energy level best works with your lifestyle? Please check one.

Mellow (short daily walks)Active (walks, dog park, playtime)Energetic (running buddy, hiking partner)

Adoption Fees (all proceeds go towards saving more dogs!)
$100 deposit is required to reserve a dog, and will go towards your adoption fee
$500 - dogs under 1 year old
$400-dogs 1 to 5 years old
$300-dogs 5 to 8 years old
$200-dogs 8 years or older
** If using venmo for payment, there is a 1.9% + $0.10 tax, per venmo business guidelines

** These fees are subject to change based on health or behavioral considerations
Transport Fees
Dogs originating from outside of New York State are subject to an additional fee of $150

** This fee helps cover transport costs and a 'Fit-to-Travel' health certificate
Spay & Neuter Agreement
All dogs of age will be spayed/neutered prior to adoption. Every dog within this rescue is required to be altered. If the dog is too young to be altered at the time of adoption, we cover the cost of future alteration at our local veterinarian. This must be completed through our account, at one of the vets we partner with, in order to be covered by our rescue. This cost will be covered in full, and an appointment is necessary prior to adoption. The information for both of our veterinarians is below.
Jefferson County SPCA
25056 Water Street
Watertown, NY 13601
(315) 782-3260
ADK Spay and Neuter
100 John Street
Hudson Falls, NY 12839
(518) 502-1022

Acknowledgement & Signature
I certify that all of the information I have given is accurate and complete. This dog will reside in my home as a pet. I will provide it with quality dog food, plenty of fresh water, indoor shelter, affection, annual physical exams and vaccinations under the supervision of a licensed Veterinarian. The rescue is able to contact any references listed on this application. If there is a life changing event and I must rehome my dog, I will contact Little Bink Rescue, so they can ensure the dog will be safely placed.
Please sign below if you have read, and agree to the entirety of this application.
Signature:

Clear
Date:

MonthDayYear
Date
How did you hear about this rescue?
Contact Information
Braelie Kempney
Carthage, NY
Ballston Spa, NY
littlebinkrescue@gmail.com
Should be Empty:

Adoption Application Form