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

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;

By submitting this form you agree to give this dog adequate time to adjust to his or her new home sometimes this can be days or weeks. You also agree that we will do a BeenVarified check on you prior to adoption. *

Signature *

Clear

Customer Details: