By clicking the box below, you agree to & understand the terms of this form.
1. If I am approved for adoption and I cannot keep the dog for any reason, it will be returned to Dalmatian Rescue of Southwest Virginia immediately.
2. I am authorizing, through submission of this form, the Veterinarian(s) named above to release any information and records concerning past or present care of animals to Dalmatian Rescue of Southwest Virginia. I agree to hold harmless and indemnify said Veterinarian(s) for providing such information.
3. I have not, nor has anyone in my household, ever been charged with any forms of animal abuse, neglect or cruelty.
4. I am at least 18 years of age and I have read this application in its entirety and have answered each question honestly and to the best of my ability.
Dalmatian Rescue of Southwest Virginia email@example.com