Rescue/Retired Adult Questionnaire

Full Name *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

Area Code Phone Number

E-mail *

Breed Inquiring about? *

Cockapoo Doodle AKC American Cocker Spaniel AKC Miniature Poodle AKC Standard Poodle

Do you prefer Male or Female? *

Male Female N/A

Coat type preference? *

Curly Wavy Smoothie No preference

How did you hear about us? *

Other

Feedback about us:

Suggestions if any for further improvement:

Will you be willing to recommend us?

Yes Maybe No

Please give reference of any two people whom you feel can give you a reference:

	Full Name	Address	Contact Number
1
2

Type a question

Own your home Fenced in yard Plan on crate training? Plan on attending Puppy Classes

Date you are wanting to add a new furbaby? *

Date Date Picker Icon

Vet Info *

Veterinarian Name and Phone#

Terms and conditions: *

By signing below, I certify that the information provided above is true and correct to the best of my knowledge.&#13;&#10;I understand that by completing this application, I will not automatically be allowed to adopt from MoonShine Babies. Lastly, I understand that if I have given any false information or I have not completely answered all questions, this application will be automatically denied. My signature below states that I understand the terms of the application and I give permission MoonShine Babies of Connersville Indiana&#13;&#10;to use any and all information provided to complete a background check.&#13;&#10;&#13;&#10;We guarantee this dog/puppy, to be in good health, to the best of our&#13;&#10;and our Vets knowledge, at the time of sale/adoption, and has had&#13;&#10;temporary required inoculations against known illnesses, Coccidia, Giardia, other parasites that are being treated does not deem your puppy unhealthy.&#13;&#10;&#13;&#10;The customer has 2 days in which to take said animal to a licensed&#13;&#10;veterinarian and must send us a copy of the vet report. The customer is strongly urged to do this.&#13;&#10;If the veterinarian finds anything seriously wrong with the animal, it&#13;&#10;will be exchanged for another puppy or dog of equal value of the&#13;&#10;customer’s choice at once, or when one is available, providing a letter&#13;&#10;from the examining veterinarian is offered as evidence of animals&#13;&#10;illness and the animal is returned within the guaranteed time as stated&#13;&#10;above (2 days). There are no exceptions. And will not cover illnesses or injuries caused by neglect or lack of knowledge.&#13;&#10;The seller assumes no responsibility on this animal after the animal&#13;&#10;has left the premises for any medical expense or mortality.&#13;&#10;All family members shall be in agreement on wanting and caring for this animal.&#13;&#10;It is understood that there is no other warranty made other than what&#13;&#10;has been stated above. In case of the death of this animal, an autopsy&#13;&#10;must be arranged for by the buyer and the findings submitted to Seller&#13;&#10;before any arrangements or exchange will be considered.&#13;&#10;&#13;&#10;The buyer agrees not to give this puppy/dog Comfortis or Trifexis oral&#13;&#10;flea medication of any oral flea medication containing the insecticide Spinosad. &#13;&#10;&#13;&#10;If you do not understand this in anyway please ask. We only offer exchanges we will not refund money if this is not agreed upon the sale will be canceled.&#13;&#10;&#13;&#10;General Adoption Fee: Dog: (Size, gender, color, and parentage determines prices)&#13;&#10;Males $200.00-$300.00 Females $200.00-$300.00&#13;&#10;Rescue Adoption Fees Vary With The Pet And The Care Needed.&#13;&#10;We sometimes have discounts available for seniors with a fixed income. Please be prepared to show proof of this.&#13;&#10;Please Note: The Adoption Fee and ANY funds paid toward a&#13;&#10;puppy/dog are non refundable. If for any reason you do not want the a&#13;&#10;puppy when one is available or decide you no longer want the puppy&#13;&#10;once it is in your care you will Not receive a refund of your Fee it is&#13;&#10;very important you read this and understand this completely.&#13;&#10;No Personal Checks, Wave invoice (paying by card) at the time of pet pick up or 10 days prior&#13;&#10;to flight departure if shipping.&#13;&#10;You are required to pick up your pet on&#13;&#10;the dates agreed upon. If your pet is not picked up by then or&#13;&#10;arrangements have been made your pet will be made available to&#13;&#10;another family.&#13;&#10;At anytime during the life of the said dog we feel the dog&#13;&#10;has been denied proper care we have the right to revoke ownership.&#13;&#10;WE RESERVE THE RIGHT TO REFUSE THE ADOPTION OF A PET TO&#13;&#10;ANYONE WE FEEL IS NOT PROPERLY PREPARED FOR THE COMMITTMENT OF CAREING FOR THE ANIMAL.&#13;&#10;I Agree to all statements on this Application Form and by signing&#13;&#10;below, I certify that the information provided above is true and correct&#13;&#10;to the best of my knowledge. I understand that by completing this&#13;&#10;application, I will not automatically be allowed to adopt from&#13;&#10;MoonShine Babies. Lastly, I understand that if I have given any false&#13;&#10;information or I have not completely answered all questions, this&#13;&#10;application will be automatically denied. My signature below states&#13;&#10;that I understand the terms of the application and I give permission&#13;&#10;MoonShine Babies of Connersville Indiana to use any and all information provided to complete a background check. &#13;&#10;{Terms please click agree below}&#13;&#10;

Signature *

Clear

Customer Details: