Adoption Application EBARR

East Bay Animal Rescue & Refuge (EBARR)

5433 Clayton Road K-#125 Clayton CA 94517 925.222.7047
Adoption Application

In order to be considered for an adoption today, you must:

*Be 18 years of age
*Have the knowledge and consent of all adults living in your household
*Have a valid ID with current address
*Have landlord’s name and telephone number (or lease)
*Understand that EBARR has the right to deny your application (based on the policies set by the board of directors.)
Your Name*

First NameLast Name
What animal are you adopting? (Species, name)*
Your Physical Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
Your Email*
Alternate Email
example@example.com
Your Phone Number*

Area CodePhone Number
Alternate Phone Number

Area CodePhone Number
CellHomeWork
DogCatMaleFemaleAdultPuppyKittenSizeOther
Occupation and where employed:*
Do you want a particular breed? If yes, what breed?*
CompanionProtectionBreedingGiftOther
Describe the temperament/personality of an ideal animal:*
How many days a week might this pet be without human companionship? *
On those days, for approximately how many hours will the pet be without human companionship?*
Please describe a normal day in your household?*
IndoorsOutdoorsDog RunCrateBasementGarageCatioOther
YesNo
YesNo
HouseApartmentCondoTrailerOther
RentOwn
If rent, please provide your Landlords name and phone number:*
YesNoOther
YesNoIf yes, How Much?Other
Please Provide the following information about your household: Number of adults: Name and ages of adults and children who live in the house:*
Is anyone in the house or family allergic to animals: *
What will you do if someone in the family develops an allergy?*
Are you aware of breed restrictions with your Homeowners and/or Renters Insurance?*
YesNo
If fenced, please describe the height and type:*
How much do you anticipate spending yearly to feed, vaccinate, license and providing medical care for your new pet?*
CatsDogsotherOther
Where are your pets now?*
List all Animals currently residing in the home: Species, Breed, Sex and age.*
Who is (was) your Veterinarian for the above animals?*
Provide Name and Phone number
Some animals require both mental and physical stimulation such as daily walks, playtime, and enrichment activities. How can you help provide these for your pet?*
YesNo
YesNo
YesNo
YesNo
If you go away for a few days, who will take care of your pet?*
If you can no longer care for your pet, what is your plan?*
If your pet becomes ill what is your plan?*
If your animal develops behavior issues what is your plan?*
Where do you plan on keeping your animal during loud environmental events (4th of July, New Years Eve, etc)?*
EBARR regularly adopts out large breed and untrained puppies. As an adopter, we expect that you train this dog either at home, with a trainer, or in a training class. Are you willing to provide this training?
Please provide initials
EBARR regularly adopts out puppies: Please understand taking care of a puppy is a lot of work, after puppyhood the dog goes into adolescence. This is also a time when a dog needs a lot of attention and exercise. By signing below, I agree if adopting a puppy to give the animal the attention it needs during these challenging times.
Please provide initials
EBARR is trusting that you will provide care and love for this pet throughout its life. If you find yourself challenged, you are required to reach out to us before it becomes a critical situation. We do our best to aid when unforeseen circumstances happen, and a family must return a pet. Please understand that to rehome a pet it could take months or even a year, and EBARR will ask that you foster until rehomed. EBARR animals are not allowed to be rehomed without reaching out to us first.
Please provide initials
EBARR adopts a pet to a specific person: if you feel you must re-home, you agree to do the following: 1. Inform the rescue of your need. 2. Provide information of the new owner so the microchip can be changed accordingly. EBARR is trusting that you will provide care and love for this pet throughout its life. If you find yourself challenged, you are required to reach out to us before it becomes a critical situation. We do our best to aid when unforeseen circumstances happen, and a family must return a pet. Please understand that to rehome a pet it could take months or even a year, and EBARR will ask that you foster until rehomed. EBARR animals are not allowed to be rehomed without reaching out to us first. EBARR animals are not allowed to be given as gifts unless disclosed at adoption. By signing below, you are agreeing to all statements above.
Please provide initials
By signing below, I certify that the information I have given is true and correct. I recognize that any misrepresentation of the facts may result in my losing privilege of adopting a pet. I authorize investigation of all statements on this application. I understand that this application is property of EBARR.
I understand the above, and have tried to the best of my knowledge to make sure all information is correct.
Thank you for taking the time to submit this form. Please feel free to contact me (the person you are adopting from) or anyone from the organization. After you click the Submit, you will be redirected to the main page, and you will also recieve a confirmation email. Thank you!
Signature date*
Signature
Should be Empty:

East Bay Animal Rescue & Refuge (EBARR)