BWM Pet Adoption Application Form

Animal I am interested in:*

Perspective Pet Parent*

First NameLast Name

Email Address*

example@example.com

Phone Number*

Name of Pet You Wish to Adopt*

Have you ever owned this type of animal or breed of dog?

YesNo

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Do you own any pets?

YesNo

Pet Name(s)

Pet Breed(s)

Pet's disposition and behavior towards other animals?

Veterinarian Name

First NameLast NameClinic

Veterinarian Phone Number

Please enter a valid phone number.

Do you own or rent your home?*

OwnRent

Please provide your landlord's information here:*

What is your landlord's pet policy?*

Do you have the proper enclosure for the pet requested?*

Do you have a yard? (DOG ONLY)

YesNo

Is it fenced? please describe (DOG ONLY)

Have you ever surrendered a pet you own to any animal shelter including a "low" or "no kill" shelter?*

YesNo

Are there children in the home? (If yes, please list ages)*

Will Your DOG be created?

YesNoN/A

If YES, about how many hours a day?

How would you deal with behavioral issues such as barking, chewing, destructive behavior, bathroom accidents indoors, unruly leash behaviors in your pet?:*

3 Personal References

Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment?*

YesNo

Please provide a detailed description:

Date

Signature of Potential Pet Parent

By clicking the submit button, I acknowledge and agree to the following:

I agree to participate in the adoption process, which includes a home check and an interview.
I understand that my personal, landlord, and veterinary references will be contacted and verified.
I acknowledge that there is an adoption donation associated with the pet I am adopting.
I understand this donation is tax-deductible under IRS 501(c)(3) guidelines and supports the organization’s ongoing rescue efforts.
I understand there is no “cooling-off” period. If I am unable or unwilling to care for my adopted pet, I agree to notify BWM by email and phone and allow a 14-day period for arrangements to return the pet safely to the Rescue Center.
I agree to indemnify and hold harmless the Rescue Center from any losses, claims, lawsuits, injuries, or damages caused by my adopted pet once the adoption is completed.
I understand that the Rescue Center will disclose any known health or behavior issues regarding the pet prior to the completion of adoption.
I agree that if I can no longer care for my pet, I will surrender the pet to the Rescue Center and provide transportation to the location determined by the organization.
I verify that all information provided in this adoption application is true and accurate.