Dog Adoption Application

Cuz i Matter Animal Rescue Dog Adoption Application

Thank you for wanting to adopt a dog from our rescue and for filling out our Adoption Application.

Procedure: Completely fill out & sign the application below. If your application is approved to move forward, someone from the rescue will be in contact with you in a few days. Please know that we are a completely volunteer based organization and depending on the number of applications received, it sometimes takes us a little longer to get through processing them. For applications selected, a vet-check will be done, then a home visit made. If you live outside the Austin area (50+ miles) we may ask you to provide some photos of your home, indoor and outside with the yard and fencing (if applicable), as we would not be able to do a home visit prior to adopting. If the adoption is approved, an adoption contract will be completed, adoption fee paid, and then you take your new canine friend home.

Today's Date*

Date

I agree I am at least 18 years of Age (We do not adopt to under 18)*

YesNo

Check each box to agree to each item regarding Medical care. You Must Agree to ALL items before submitting your application.

NOTE: once all vaccines and/or the spay/neuter surgery is completed with Cuz i Matter Animal Rescue, you are free to use whatever vet you choose.

Signature for Agree to Medical Care Items Above*

Enter Dog(s) Applying For

Breed/Type(s) Applying For:

How did you hear about Cuz i Matter Animal Rescue (be specific please)?

Applicant Name*

First NameLast Name

E-mail*

Address Information*

Address

City

State

Zip Code

CityStateZip

Primary Phone*

CellHomeWork

Phone Number - Cell

Phone Number - Home

Place of Employment*

Employment Since*

Date

Phone Number - Work

1. Why do you want to adopt a dog?*

2. What do you think are the most important responsibilities in adopting a dog?*

3. Please list any preferences (age, size, sex, breed, personality):

4. Have you submitted an application with another organization for a dog at this time?*

NoYes

5. Have you ever had an application declined for adoption of an animal from an animal welfare group/animal control facility?*

NoYes

If Yes please explain

6. Are you willing to take the time to housebreak a dog, and do you understand that changing a dog's environment may cause the dog to have accidents?*

YesNo

7. If a behavioral problem arises, what steps will you take to work on it? *

8. If you are applying for a puppy/dog, who is not housetrained, how would you housetrain the dog (please explain how)?*

9. Does any member of the family have any allergies to animals?*

NoYes

If Yes, please explain

10. Please describe the kinds of personal situations where you might have to return your adopted dog, i.e., job loss, children, move, marital change, etc..

11. For whom are you adopting the dog?*

Please Explain

12. How many people live in your home?

13. Are there any children in the household?*

NoYes

What are the children(s) ages?

14. Who will be responsible for feeding and taking the dog outside?*

15. Who will take care of the dog in the absence of the primary caretaker?*

16. Will you offer your dog obedience training?*

NoYes

What type of Training will you provide:

Describe all the Pets you currently own. Click the "Add Additional Animal" button below the questions, to Add a new Animal

Click the "Add Additional Animal" button to Enter Your Animal's Information

I do not have any pets

Yes

17. Describe those pets you currently own (10 max)

Describe all the Pets you have previously owned in the last 10 years. Click the "Add Additional Animal" button below to Add a new Animal

I have not had any previous pets

Yes

18. Describe all pets you previously owned in the last 10 years (10 max)

List each Vet/Animal Hospital where your animal(s) received care over the last 5 years. If you have no current/previous pets and/or no vets were used, you may Skip to Question 20 and leave Question 19 empty.

NOTE: The application review cannot be completed unless each vet's phone number is provided.

19a. List each Vet/Animal Hospital where your animal(s) received care over the last 5 years. Click the "Add New Vet" button to Add Additional Vets

19b. What owner name(s) are the vet records listed under?

* Note some vets require authorization from you the pet owner, before they will release any information to us regarding your pet(s) medical care. Having to get this information may slow down the approval process of your application. Please confirm with your vet if this authorization is required by them.

19c. Additional Comments regarding the Vet care for the pet(s) you noted?

20a. Name of the Vet you will use for your new pet*

20b. Phone Number of the Vet you will use for your new pet*

21. What kind of Veterinary Care do you plan to provide?*

22. Have you considered the extra expenses that will come with having a dog including vet care, food, supplies, equipment, toys, training, emergency medical care and boarding?*

YesNo

23. What type of home do you live in:*

24. Do you own or rent your residence?*

OwnRent

24a. If you rent, please indicate Landlord's Name:

24b. Landlord's Phone Number:

24c. What type/size pets are allowed, if the home is Rented?

* Please make sure you are also aware of your landlord's breed restrictions and pet fees

25. Do you have a fenced yard?*

YesNoPartialOther

25a. What Type of Fence?

25b. How Tall? (Give range of heights, if relevant)

25c. Any holes and/or gaps where a small animal could fit through (i.e.: between bars, holes in wood or gaps under fence)?

NoYes

Please explain the holes and/or gaps

26. How often would you exercise the dog for and approximately how long?*

27. How many hours in a day would the dog be left unattended?*

Enter 0 to 24

27a. When left unattended, where will the dog be kept during that time?*

28. When you are home, where will the dog be kept during that time?*

29. Where will the dog sleep at night?*

30. When no one is home (i.e.: at work, shopping), where would the dog stay (please be specific)?*

31. If you travel, what will you do with the dog while you are gone?*

32. If you move, what will you do with the dog?*

33. Are you or your spouse/partner with the Military?*

NoYes

34. Are you aware CiMAR requires all dogs/cats in the home be spayed/neutered as well as up-to-date on all vaccines and be on heartworm preventative?*

YesNo

35. Are you aware the Adoption Fee is Non-Refundable?*

YesNo

36. Are you aware that all Adopters of CiMAR dogs are required to provide Heartworm Prevention?*

YesNo

36a. Will this Heartworm Prevention be a financial strain for you? Note: this can be purchased for as low as $7 per month*

NoYes

37. Are you familiar with your local animal control laws?*

YesNo

38. Have all ADULT family members met with and/or all members have agreed upon the dog?*

YesNo

39. Additional Comments to Provide

Enter any additional comments/notes you would like to convey to Cuz i Matter Animal Rescue

Please provide 3 references NOT RELATED TO YOU with whom CiMAR can speak to in regards to your application.

Please NOTE: we consider boyfriend/girlfriend/partners to be related to you.

Reference #1: Full Name*

First NameLast Name

Relation to applicant(s):*

Phone Number*

Reference #2: Full Name*

First NameLast Name

Relation to applicant(s): *

Phone Number*

Reference #3: Full Name*

First NameLast Name

Relation to applicant(s):*

Phone Number*

Medical Care: I understand the Medical Care included in the adoption fee is done In-House.

I understand that omission of information and/or failure to answer all questions and failure to sign the application can result in this application being declined. Also, if an omission or untruth is discovered after an adoption is made, or if CiMAR determines the dog is not cared for properly, I understand that CiMAR reserves the right to reclaim the animal at any time. I give CiMAR permission to fully investigate the information provided as well as contact veterinarians and related officials. If the application passes this review, I agree to a home visit on a mutually agreed date by a CiMAR volunteer before an adoption decision is made.

In addition, I understand the adoption arrangement is dependent on many factors, including but not limited to the compatibility of the family and home to the individual animal. I understand it is CiMAR’s prerogative to decide which adoption homes meet our needs and standards, and that their (CiMAR) decision is final. Unless otherwise indicated by CiMAR, I am free to apply and undergo the adoption application process in the future.

I have read the above information carefully and have filled out this application honestly.

Signature*