Waller Animal Shelter & Rescue Adoption Form
Please fill out one form per dog
Dog applying to adopt- Type name of dog and breed
*
Name
*
Driver's license state and number
*
Date of Birth
*
E-mail
*
Phone Number
*
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Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How many adults and children are there in your family residing at the residence and their ages?
*
What type of home do you live in single family, town home,apartment, farm, etc.?
*
If you rent, please give the rules governing pets and the landlord’s name and number:(by providing this information you are allowing City of Waller Animal Shelter & Rescue to contact your landlord, please inform them of this call so they will speak with us) OTHERWISE TYPE N/A
*
Is everyone living in the household agreed on the decision to adopt a dog?
*
Yes
No
What other pets do you have?
*
Are your current pets neutered/spayed?
*
Yes
No
Are your current pets vaccinated?
*
Yes
No
Will this be an indoor or outdoor pet?
*
Indoor
Outdoor
Name and number of your current vet?
*
Have you ever surrendered a pet?
*
Yes
No
Do you agree to take financial responsibility for this dog?
*
Yes
No
Do you have a fenced in yard?
*
Yes
No
Do you agree to keep this dog indoors?
*
Yes
No
Can you provide adequate time and attention to the dog?
*
Yes
No
All of the information I have given is true 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 examination and vaccinations under the super vision of a licensed Veterinarian. I agree that I will care for this dog in a safe and humane manner, and as a family pet and companion. The dog will have appropriate food, water, shelter and medical care for the duration of his/her life. I understand that the CURRENT OWNER makes no guarantees or warranties regarding the health or temperament of this dog. The CURRENT OWNER shall not be held liable for the behavior of this dog or any damages it may cause after ownership has been transferred. I enter into this agreement of my own free will and understand that this is a binding contract enforceable by civil law. DATE BELOW
*
-
Month
-
Day
Year
Date
Adoption Applicant's Signature
Submit
Should be Empty: