SGAR adoption appl

The adoption fee for ALL Saving Grace dogs is $150. The adoption fee includes: de-worming, age appropriate vaccinations, spay/neuter, heartworm test (for dogs over 6 months of age), and rabies shot (for dogs over 16 weeks of age). Please note that this does NOT include microchipping. Micro- chipping is available from our vet for an additional fee.

Saving Grace Animal Refuge is an all-volunteer rescue. We also have full-time jobs and families. We will try to answer all questions and applications in a timely manner. Please be patient and bear with us . Do Not contact our vet as they are a vet clinic and can not answer questions on behalf of Saving Grace. All questions and comments must go directly through the rescue. Thank you for your understanding.

Dogs Name

Contact Information

Name

First NameLast Name

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Family & Housing

How many adults live in your home? *

Put N/A only if you have no other adults living in your home with you.

How many children live in your home? *

Ages? *

Put N/A in field only if there are no children living in your home.

Do you own or rent your home? *

Landlord name and phone number *

Put N/A in field only if you own your home.

(by providing this information you are allowing SAVING GRACE ANIMAL REFUGE to contact your landlord, please inform them of this call so they will speak with us)

Do you have a fenced yard? *

If you do not have a fenced yard, how do you plan to supervise the dog while outside? *

Does anyone in your family have a known allergy to dogs? *

Is everyone in agreement to adopt a dog*

Do you have the time to provide adequate love and attention?*

Other Pets

What other pets do you have? List all age, sex and breed.*

Are these pets up to date on vaccinations?*

Are these pets on heartworm prevention?*

Are these pets spayed/neutered? If not, why?*

Put N/A in field only if you do not have other pets in your home.

Have you ever surrendered a pet to a rescue or shelter? If so, why?*

Have you ever had a pet euthanized? If so, why*

Have you ever lost a pet to an accident? If so, please describe what happened*

How do you discipline your pets?*

Veterinarian

Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Name records are kept under?*

by providing this information you are allowing SAVING GRACE ANIMAL REFUGE to contact your vet. Please call and authorize them to release the information

Will this dog be kept indoors or outdoors?*

Where will the dog spend the day? (Describe)*

Where will the dog spend the night? Describe *

Number of hours (average) the dog will spend alone?*

Do you agree to provide regular vet care for this animal by a Licensed veterinarian*

Are you willing to let a representative of Saving Grace Animal Refuge visit your home by appointment?*

Personal Reference

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Area CodePhone Number

I UNDERSTAND AND ACKNOWLEDGE THE FOLLOWING -- PLEASE INITIAL EACH!

I have 5 days to take my newly adopted dog to my own personal vet to ensure he or she is healthy. *

Saving Grace is not responsible for any damage to property or persons once the pet is in my care.*

If any issue arises within the first 5 days after adoption, I understand a full refund of the adoption fee will be given only with the return of the animal. *

If for any reason I cannot keep this pet in the future, it MUST be returned to Saving Grace Animal Refuge and cannot be re-homed by me or anyone else! No refund will be issued after 5 days*

I understand that in most cases Saving Grace Animal Refuge has no previous history of the animals in their care. These animals are often strays and this includes but is not limited to vetting history. *

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 supervision of a licensed Veterinarian*

Signature*

Date

Saving Grace Animal Refuge, Inc.