Adoption Application Form

How did you hear about Cow Dog Rescue

Full Name*

First NameLast Name

Age

E-mail*

What is the name of the dog you are interested in adopting?*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Do you live in a:

Do you:

OwnRentLive with ParentsOther

If Renting: Please indicate landlord contact information

Household Setting

RuralSuburbanUrban

Describe your Homes Activity Level

Busy/NoisyModerate Comings/GoingsQuiet with Occasional Guests

Please List all People Living in the Household (Include Name, Relationship, Gender and Age)*

Does Anyone in your Household have Allergies to Animals?

YesNo

Are all members of your Family agreeable to Adopting a Dog?

YesNo

Please List any Pets you have had in the past 2 years, living & deceased (Please include Name, Breed, Age, Altered, Sexe, UTD Vaccines, Heartworm, Living/Deceased)*

Please describe the type of dog you are wanting to adopt if you are not applying for a specific dog.

Are you willing to take your dog to vet appointments annually for immunizations and as needed if health problems arise?

YesNo

Are you prepared to love your dog, take care of your dog, and commit to them for the rest of their life?

YesNo

If No please explain

Are you willing and able to give your dog a monthly heartworm preventative?

YesNo

We cannot guarantee a dog to be housebroken, are you equipped to train with love and patience?

YesNo

Have you had any experience with with an emotionally or physically neglected or abused dog?

YesNo

If Yes please explain

Are you willing to use a crate for a dog if recommended?

YesNo

Do you have a fenced yard?

YesNoPartial

If fenced, please give details on height, material, # of gates, are gates locked or lockable?

How many hours in a day would the dog be left alone? If the dog will be left home alone for more than 4 hours at a time, where will he stay? (Outside, free to roam inside, crates, etc.)

What are you plans to exercise your dog? Please list any parks near by or trails, how many walks a day, approximate length, and activities such as agility.

Vet Reference: *

Vet’s Name Name of Clinic

Vet Clinic Phone Number

Area CodePhone Number

Please list 3 personal references with names, phone numbers and how related. We prefer it not to be all relatives. Are you ok with this?

YesNo

Reference #1: Full Name*

First NameLast Name

Relation to applicant(s):

Phone Number

Area CodePhone Number

Reference #2: Full Name*

First NameLast Name

Relation to applicant(s):

Phone Number

Area CodePhone Number

Reference #3: Full Name

First NameLast Name

Relation to applicant(s):

Phone Number

Area CodePhone Number

BY SENDING THIS ELECTRONICALLY, I ACKNOWLEDGE THAT I HAVE COMPLETELY READ THIS QUESTIONNAIRE AND COMPREHEND IT FULLY. I UNDERSTAND THAT APPLYING DOES NOT ENSURE APPROVAL AND THAT UNTRUTHFUL ANSWERS OR FAILURE TO COMPLY WITH THE REQUIREMENTS OF THIS APPLICATION CAN RESULT IN THE FORFEITURE OF ANY COW DOG RESCUE DOG ADOPTED BY ME. I CERTIFY THAT THE ABOVE INFORMATION IS CORRECT, AND I UNDERSTAND THAT THE INFORMATION WILL BE VERIFIED. I AGREE TO HAVE COW DOG RESCUE COMPLETE REFERENCE CALLS AND CONDUCT A HOME VISIT INSPECTION TO BE ABLE TO APPROVE MY APPLICATION.

I UNDERSTAND THAT THE ADOPTION OF ANY PET IS A COMMITMENT TO PROVIDE LOVE, SHELTER AND CARE TO HIM/HER FOR THE DURATION OF
HIS/HER LIFE. I CERTIFY HERE THAT I AM READY TO MAKE THIS COMMITMENT WITH THE FULL KNOWLEDGE THAT MY PET MAY LIVE TO EXCEED 15 YEARS OF AGE. I AM PREPARED TO BE FINANCIALLY RESPONSIBLE FOR VETERINARY CARE INCLUDING BUT NOT LIMITED TO ANNUAL CHECK UPS, MONTHLY HEARTWORM PREVENTATIVE AND ANNUAL VACCINATIONS. I AM PREPARED TO PROVIDE GROOMING, EXERCISE AND SOCIAL INTERACTION FOR THE PET. MY FINANCIAL RESPONSIBILITY BEGINS THE DATE OF THIS CONTRACT.

ADOPTION DONATION: THE DONATION OF $150 IS NOT A FEE OR SALES PRICE, BUT A REQUEST TO DEFER OR REIMBURSE COW DOG RESCUE FOR
SOME OF THE MEDICAL EXPENSES, OR OTHER EXPENSES INCURRED BY EFFORTS TO RESCUE, REHABILITATE AND REHOME THIS PET. THIS
DONATION IS NOT REFUNDABLE.

IMPORTANT NOTICE REGARDING TEMPERAMENT: COW DOG RESCUE MAKES NO EXPLICIT OR IMPLICIT GUARANTEES IN REFERENCE TO THE HEALTH AND / OR TEMPERAMENT OF THIS PET. THE PET IS ADOPTED “AS IS” AND THE ADOPTER ASSUMES ALL RESPONSIBILITY FOR TREATMENT AND OF ANY AND ALL EXISTING CONDITIONS OR ANY OTHER CONDITIONS OF PHYSICAL OR TEMPERAMENT CHANGES THAT MAY OCCUR FROM THE DATE OF THIS ADOPTION CONTRACT FORWARD INCLUDING ANNUAL VACCINATIONS.

COW DOG RESCUE MAKES EVERY EFFORT TO PLACE HEALTHY ANIMALS. HOWEVER, WE CANNOT GUARANTEE THE HEALTH OF ANY ANIMAL AND SHALL NOT BE HELD RESPONSIBLE FOR ANY MEDICAL EXPENSES WHICH MAY BE INCURRED FROM THE DATE OF THIS CONTRACT AND
FORWARD, HEREBY EXPRESSLY EXCLUDING ANY IMPLIED OR EXPRESS WARRANTIES OF MERCHANTABILITY OR FITNESS FOR ANY PARTICULAR PURPOSE INCLUDING WITHOUT LIMITATION, ANY WARRANTIES REGARDING HEALTH, TEMPERAMENT OR WHETHER THE ANIMAL IS HOUSEBROKEN.

SHOULD ADOPTER BECOME UNABLE AND/OR DECIDE TO NOT KEEP THE PET FOR ANY REASON, THE ADOPTER AGREES TO CONTACT COW DOG RESCUE TO ARRANGE FOR THE RETURN OF THE ANIMAL. ADOPTER MAY NOT REHOME THE PET. THE PET MUST BE REHOMED THROUGH COW DOG RESCUE OR AN APPROVED ADOPTION AGENCY IF OUTSIDE THE SAN ANGELO AREA. THE PET MAY NOT BE SOLD, OFFERED “FREE TO GOOD HOME” OR SURRENDERED TO A SHELTER. THE ADOPTER UNDERSTANDS AND AGREES THAT COW DOG RESCUE WILL REQUIRE ADOPTER TO PROVIDE CARE AND SHELTER FOR 14 DAYS FROM THE DATE THE AGENCY IS NOTIFIED OF THE ADOPTERS DESIRE TO RETURN THE PET. COW DOG RESCUE DOES NOT HAVE THE RESOURCES TO TAKE IMMEDIATE POSSESSION OF A RETURNED PET. IF THE ADOPTER IS NOT ABLE TO OR REFUSES TO PROVIDE CARE AND SHELTER FOR THE REQUIRED 14 DAYS, THE ADOPTER AGREES TO MAKE A DONATION OF $250.00 TO PROVIDE FOR TEMPORARY BOARDING OF THE ANIMAL AT A VETERINARY FACILITY UNTIL A FOSTER HOME OR PERMANENT HOME CAN BE LOCATED.

RELEASE OF ALL CLAIMS AND WAIVER OF RIGHT TO SUE: THE ADOPTER UNDERSTANDS AND AGREES THAT OWNING A PET INVOLVES CERTAIN INHERENT RISKS AND DANGERS OF ACCIDENT, INJURY OR EVEN DEATH. I UNDERSTAND AND AGREE THAT I FULLY AND FREELY ACCEPT ALL RESPONSIBILITY OF ANY INJURY WHICH MAY OCCUR TO ME, MY PET AND/OR MY PROPERTY AND THAT NEITHER COW DOG RESCUE, PETSMART, PETCO, THE CITY OF SAN ANGELO, OR ANY OTHER MEMBER, VOLUNTEER, DIRECTOR, EMPLOYEE OR AGENT, SERVANT, PARTNERSHIP, BUSINESS ENTITY OR PERSON ASSOCIATED WITH ANY OF THOSE NAMED CAN BE HELD RESPONSIBLE IN ANY MANNER, EVEN FOR THEIR OWN
NEGLIGENCE, FOR ANY INJURY OR ANY NATURE TO ME, MY PET OR MY PROPERTY. ADOPTER HEREBY RELEASES, ACQUITS, AND FOREVER DISCHARGES COW DOG RESCUE, PETSMART, PETCO, THE CITY OF SAN ANGELO, OR ANY MEMBER, DIRECTOR, EMPLOYEE, AGENT, SERVANT,
PARTNERSHIP, BUSINESS ENTITY OR PERSON ASSOCIATED WITH ANY OF THOSE NAMED FROM ANY AND ALL LIABILITY FOR INJURY OR DEATH CAUSED TO ME, MY PET OR MY PROPERTY AS A RESLUT OF THEIR NEGLLIGENCE WHICH MAY OCCUR TO ME IN THE FUTURE, OR FOR ANY REASON
WHATSOEVER. ADOPTER FURTHER AGREES TO INDEMNIFY AND HOLD HARMLESS COW DOG RESCUE, PETCO, PETSMART, CITY OF SAN ANGELO OR ANY MEMBER, DIRECTOR, EMPLOYEE, AGENT, SERVANT, PARTNERSHIP, BUSINESS ENTITY OR PERSON ASSOCIATED WITH ANY OF THOSE NAMED FOR THEIR OWN NEGLIGENCE AND ANY INJURIES, DEATH OR DAMAGES CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF ANY OF THE PARTIES HEREIN INDEMNIFIED.
ADOPTER ACKNOWLEDGES THAT I HAVE READ AND UNDERSTAND THIS AGREEMENT, THE INTENDED EFFECT OF WHICH IS TO RELEASE FROM LIABILITY, EVEN FOR MATTERS THAT MAY OCCUR IN THE FUTURE, COW DOG RESCUE, PETCO, PETSMART, THE CITY OF SAN ANGELO, OR ANY
OTHER MEMBER, DIRECTOR, EMPLOYEE, AGENT, SERVANT, PARTNERSHIP, BUSINESS ENTITY OR PERSON ASSOCIATED WITH ANY OF THOSE NAMED AND THAT THIS AGREEMENT SHALL BE BINDING UPON ME, MY HEIRS, EXECUTORS, ADMINISTRATORS OR ASSIGNS. I FURTHER WAIVE MY
RIGHT TO SUE IN THE EVENT OF INJURY, ANY OF THOSE PERSONS NAMED ABOVE OR ANYONE ACTING THROUGH THEM OR ON THEIR BEHALF.

Date

MonthDayYear

Your name*

E-mail