Jersey Pits Adoption Application and Contract

First and Last Name:*

Do any other adults live with you? If yes, list their names, ages, relation, phone numbers, occupations, and Instagram/FB names:*

FULL current residential address (house number, street name, town, state, zip code):*

Phone Number:*

Date of Birth / Age:*

Email Address:*

Which dog(s) are you most interested in, and why?*

If your preferred dog is not available, are you open to discussing other potential matches for your family?*

Do you currently have any pets?*

YesNo

If YES, please include ALL of the following information: ANIMAL TYPE, NAME, AGE, GENDER, BREED, WEIGHT, WHERE HE OR SHE CAME FROM, CURRENT VACCINATION STATUS, and CURRENT SPAY / NEUTER STATUS?*

Please provide the NAME, ADDRESS and PHONE NUMBER of your current VET. Please list the names of the pets under their care (past and current pets):*

Have you used other vets/clinics/pet stores for your pet's most recent vaccinations? If yes, please provide the business name and number:*

Please list any pets that you've had within the last 5 years and why they are no longer with you:*

Instagram/Facebook names:*

Occupation:*

Employer name AND contact information: *

What are your reasons behind your decision to adopt at this time?*

Please describe for us your IDEAL dog (age, size, gender, breed, temperament, personality etc.):*

When are you able to welcome a new dog into your home?*

Do any children live with you? If yes, list their names, ages and behavior around dogs: *

Is everyone in your household aware of your plans to adopt and are they also on board to adopt? If yes, please explain: *

Does anyone in your household have allergies or asthma? If yes, please explain:*

Which of the following words would you use to describe your household?*

Typically, how many hours a day will your dog be left alone (without adult supervision)?*

Where will your new dog stay during the day when left alone? If you answered yes to currently having pets, please explain where they stay during the day:*

Where will your new dog sleep at night? If you answered yes to currently having pets, please explain where they sleep at night:*

What type of exercise will your new pet receive (how often/duration)? If you answered yes to currently having pets, please explain the current daily exercise they receive:*

What type of home do you live in?

Do you rent or own your home?*

RentOwnOther

If you answered "rent", provide your landlord's name AND contact information:

If you answered "rent", upload a copy of your lease agreement. If you own, but live in a condo or townhouse, upload your HOA by-laws, including pet policies.

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If you answered "rent", when does your lease expire and what are your housing plans at that time?:

How long have you lived at your current address? *

Does your home have any pet / breed / weight restrictions that you are aware of? If YES, please EXPLAIN the restrictions:*

Do you have a fenced in yard? If yes, what type of fence do you have?:*

Any major changes to occur in your household over the next year (that you are aware of)? For example: moving, new baby, renovations, new roomate, etc. If yes, please explain:*

Are there any non-resident children that regularly visit your home? If yes, what are their names, ages, and how often do they visit?*

Do any other pets ever visit your home? If yes, please list all visiting pets (name /breed/ gender/ age/ UTD on shots/ spayed neutered):*

How often do you travel for work/leisure:*

Where will your new dog stay if/when you travel? If you answered yes to currently having pets, please explain where they stay when you travel:*

Have you ever surrendered or returned an animal to a shelter or rescue? Have you ever given away or re-homed an animal? If yes, please explain the circumstances:*

Have you ever fostered / adopted or attempted to foster / adopt from an animal welfare group before? If yes, please share your experience and the name of the rescue(s) or shelter(s):*

Have you ever had an animal euthanized for any reason other than old age or terminal illness? If yes, please explain:*

Hypothetically speaking, what would potentially cause you to return an adopted dog? What would you do on your end to prior to initiating a return?*

Please provide the name, relation, address and phone number of one PERSONAL reference:*

Please provide the name, relation, address and phone number of one PROFESSIONAL reference:*

Please provide the name, relation, address and phone number of one EMERGENCY CONTACT:*

Do you have experience with abused, traumatized or neglected dogs? If yes, please explain your experience:*

Do you have bully breed or pittie experience? If yes, please explain your experience:*

Please check all that apply: I am willing to...*

Crate TrainHouse TrainProvide daily exerciseProvide a 2 week decompresson periodProvide your new dog with structure and boundariesWork through issues that may arise with your new petHire a professional trainer if needed

Do you have a thorough understanding of the expenses that go along with dog ownership? Are you willing and able to provide for all of your adopted dog's needs?*

Do you view pets as family members? Why or why not?*

Do you believe in committing to pets for the duration of their lifetime? Why or why not?*

What are some ways you will set your adopted pet up for long-term success and safety?*

What are some ways you will promote the mental and physical health of your adopted pet?*

Please use this space to brag, or to share with us anything you would like for us to know about your family:

Feel free to upload any photos you'd like to share with us of your family or your current pet(s) living their best lives!

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Jersey Pits Rescue Inc. Adoption and Foster-to-Adopt Contract / Waiver Acknowledgement

-I acknowledge that falsification of information on my adoption application can result in my being denied adoption of an animal or, if an animal has been adopted to me, the return of that animal to Jersey Pits Rescue Inc.
-I understand that all animals adopted from Jersey Pits Rescue Inc. will be Spayed/Neutered and Microchipped. I can either use their vet in Union, NJ or my own vet at my own expense. If I use my own vet, I agree to send proof to Jersey Pits Rescue.
-I agree to provide a safe and stable environment, love, and proper care for my adoptive dog. I understand that it is my responsibility to provide the dog with a proper home and that the dog will be an indoor pet only.
-I agree that unless directed by a licensed veterinarian for reasons related to health and the welfare of the animal, cosmetic surgery will not be performed under any circumstances. Including but not limited to ear cropping and tail docking.
-I agree that the animal will immediately be licensed with the local and/or state authorities as required by law.
-I agree to continue all proper vetting for my dog and understand that is my financial responsibility after adopting.
-I agree that Jersey Pits Rescue Inc. is not responsible for any illness or injury caused by any animals, including my adopted dog.
-I agree to hold Jersey Pits Rescue Inc. harmless and release from liability should I become sick or injured as a result of my adopted dog.
-I agree that Jersey Pits Rescue Inc. cannot, and does not make any guarantees as to the health, temperament, mental disposition, and training of the dog. I hereby adopt the dog at my own risk.
-I agree that I fully and completely release Jersey Pits Rescue Inc., its founders, fosters and volunteers, from any and all claims and liability, including, but not limited to: any defects or illnesses the dog may have or develop, and for any injury or damage to persons, property, or other household pets, which may be caused by the adopted dog.
-I agree to indemnify and hold Jersey Pits Rescue Inc. harmless against any and all claims and liability, including, but not limited to, those asserted by third parties for any injury or damage to persons or property caused by the adopted dog.
-I certify that I have never been convicted of animal cruelty, neglect, or abandonment by a court of law or other governmental authority.
-I agree that in cases of suspected neglect or abuse, I will allow Jersey Pits Rescue Inc. to visit my home to check on the health and welfare of the dog if deemed necessary.
-I agree that Jersey Pits Rescue Inc. is not required to reimburse me for supplies, or training unless otherwise specified by the rescue.
-I understand that Jersey Pits Rescue Inc. may pursue legal means to redress any harm or neglect done to the dog/puppy that should occur while in my care. All legal fees and court costs in the event that this matter is forwarded to an attorney for enforcement will be the responsibility of the adopter.
-I agree not to post negative comments about the rescue, (Jersey Pits Rescue Inc.) its dogs, volunteers, fosters or owners . I also agree not to harass the rescue, (Jersey Pits Rescue Inc.) its owners, fosters or volunteers.
-I acknowledge that the adoption fee donation is $400.00 unless otherwise specified by the rescue and it is non-refundable. Acceptable methods of payment include: Venmo (@JerseyPits-Rescue), PayPal (jerseypitsrescue@gmail.com), Cash or Check.
-In the case of a return in the future, I understand that the dog is not to be given away, euthanized or sold. If for any reason I cannot keep the animal, I will legally sign ownership back over to Jersey Pits Rescue Inc. (unless otherwise specified by the rescue). I agree to give Jersey Pits Rescue Inc. 24 hours to respond and 48 hours to find placement for my adopted dog. Since Jersey Pits Rescue Inc. does not have a facility, I agree to pay for 10 days of boarding if needed and understand that I am required to transport the dog to the boarding facility.
-I understand that this contract for adoption is legal and binding, and will be governed by the laws of the State of New Jersey. I understand, consent and agree to the terms of this Agreement. I realize that by signing this Agreement, I am giving up certain rights and assuming certain liabilities, and I am doing so freely, willingly, and with the knowledge thereof. I understand that this agreement shall bind and extend to other members of my family, heirs, executors, administrators and representatives. I agree that my signature (electronic or written) is considered binding when adhering to the terms above.

Electronic Signature:*

Date:*

Jersey Pits Rescue Inc. Adoption Application & Contract