Rescue4All Adoption Application

Mission Statement: To find caring, loving, permanent homes for surrendered, abandoned or neglected animals. Rescue 4 All hopes to ease the problem of the population overflow occurring in many of our shelters today. We educate the individual on the importance of commitment to an animal for their life, spay and neutering ALL pets, and providing superior care and compassion.

**Please note only fully completed applications will be responded to

**Fields marked with an "*" are required and your application will not be submitted unless they are completed

I/We certify that all the information provided on my/our Adoption Application is true, correct, and accurate. I/We understand that omitting information and/or providing false or misleading information will nullify my/our adoption application and all other future agreements/contracts. *

Yes

I have thoroughly read the entire HOW TO ADOPT page & understand what I read. If not please go to https://www.rescue4all.org/adopt-r4a and thoroughly read it before proceeding. *

Yes, I have thoroughly read the HOW TO ADOPT page and understand what I have read

I have thoroughly read the entire OUR PROCESS page & understand what I read. If not please go to https://www.rescue4all.org/r4a-adoption-process and thoroughly read it before proceeding. *

Yes, I have thoroughly read the OUR PROCESS page and understand what I have read

Date submitted *

Are you interested in any particular animal: *

Yes No

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

We are not a "first come first serve" rescue.

Our number one goal is the find the BEST home possible for our dogs. They are our priority.

ONLY approved adopters can meet our animals.

All applicants must be over the age of 18. If married or jointly adopting an animal all individuals must be listed and complete the application

Primary Applicant

Applicant 1: First and Last Name *

Your Age *

YOUR Physical Address *

City *

State *

Zip *

Mailing Address, if different than physical address

City

State

Zip

Preferred phone *

Phone we can text you on

Work Phone

E-Mail *

Drivers License Number *

Issuing State *

(**We use your driver license for a criminal background check to ensure you have no violent convictions or instances related to animals or humans.)

Spouse/Joint Applicant

Any adult in the household who will be participating in the care of the animal must be included here.

Applicant 2: First and Last Name

Age

Physical Address

City

State

Zip

Mailing Address, if different than physical address

City

State

Zip

Home Phone

Cell Phone

Work Phone

E-Mail

Drivers License Number

Issuing State

(**We use your driver license for a criminal background check to ensure you have no violent convictions or instances related to animals or humans.)

Employment Information:Applicant 1

If you are employed you must FULLY complete ALL of the information below.

Are you employed? *

Yes No

Employer

Occupation

Address

City

State

Zip

Phone Number

How long at present job

Employment Information:Applicant 2

Are you employed?

Yes No

Employer

Occupation

Address

City

State

Zip

Phone Number

How long at present job

Non-Relational Personal Reference (Other Than Relative/Spouse/Significant Other)

Name *

Relationship *

Years Known *

Home Address

City

State

Zip

Phone *

Best time to call

Home Environment Information

Do you live in a: *

House Apartment Townhome Condo Other

If other, please describe:

Do you: *

Own Rent

IF RENTING: Please email a copy of your lease stating the pet policy or your landlord's WRITTEN permission allowing you to have a dog. Send documents to adoptions@rescue4all.org. We will not respond to your application until this documentation is received.

Are there any breed or weight restrictions:

Yes No

If so, please describe:

Landlord's Contact Information

Name

Phone Number

**If you are a renter, please email a copy of your lease stating the pet policy or written permission from your landlord to have a dog to adoptions@rescue4all.org. Your application will not be responded to until we have received this documentation.

**If you live in a condominium/co-op, or your house is part of a homeowners association, please email a copy of the bylaws, rules and regulations of such organization stating that there are no restrictions regarding owning a dog to adoptions@rescue4all.org. If there is a limit on the number of pets you are allowed, please note the limit on the copy of the bylaws.

How long have you lived at this address:

Do you have a fenced yard: *

Yes No

What size is the yard:

Is the yard completely fenced:

Yes No

Please specify the fence type and height:

If no fence, how will you handle the dogs exercise and potty needs, etc.?

How many adults are in the household, please give names and ages of each: *

How many children are in the household, please give first names and ages of each: *

Do you or anyone in your family have allergies related to animals:

Yes No

Are all family members in agreement to adopt this animal:

Yes No

Pet Ownership Information

If you have a veterinary clinic that you have been to more than once you are required to disclose that information below.

Do you have a regular veterinary clinic: *

Yes No

We you authorize Rescue 4 All to contact your veterinary clinic(s) for your vet history? *

Yes We do not have a regular veterinary clinic

Name of veterinarian

Name of clinic

Address

State

Zip

Clinic Phone

Please use this space if you need to additional space for any/all veterinary clinic information:

Have you ever re-homed an animal? *

Yes No

If yes, explain when and why:

How many animals have you owned in the last 15 years: *

You must list ALL animals that you have owned in the past 15 years, but no longer have. Include the years you owned them, Name, Age, Sex, Breed, if Spayed/Neutered and what happened to them *

List all animals you PRESENTLY HAVE, give Name, Type of Animal, Age, Sex, Breed and if Spayed or Neutered: *

**Please note that R4A will not adopt to individuals that currently have animals that are NOT Spayed or Neutered.**

If you currently have another dog, or more than one, please describe how he/she is with other dogs? Answer & explain:

Describe your ideal dog:

What (if anything) that might be an issue or a “deal breaker” for a new dog?

What are your plans for this pet?

Do you want to adopt a:

Male Female Indifferent

Where will the dog spend the day *

On average, how many hours will the dog spend WITHOUT human company each day: *

Where will the dog spend the night? *

Do you agree to license this dog and give him/her regular vet care: *

Yes No

Are you willing for someone from the Rescue4All to visit your home by appointment? *

Yes No

**A home visit is a requirement of our adoption process**

Do you agree to contact the Rescue 4 All if you can no longer keep this dog at any point in time? *

Yes No

In situations where we do not have a dog that fits your needs, may we share your application with other rescue organizations?

Yes No

I/We certify that the information provided on my Adoption Application is true and understand that false information will nullify this adoption and be regarded as breach of contract. All of the above information I have given is true and complete. If I adopt a dog from Rescue4All, the dog will reside in my home as a pet. I will provide him/her with adequate water, a high quality dog food, shelter, training, affection and medical care. I understand that the Rescue 4 All is a referral service and is not responsible for the accuracy of information received about the habits, temperament, or physical condition of the dogs available for adoption. I understand it is my responsibility to evaluate a dog for myself before agreeing to adopt him/her. I am in full agreement of the terms of the adoption. Rescue4All shall not be liable for, and is hereby relieved from, all liability for any damage, expenses, causes of action, fines, suits, demands, judgments, or claims of any nature whatsoever arising from or by any reason of any damage to property or injury to any persons caused in whole or in part during the visitation of the dog up for adoption and a dog placed in your home. I hereby accept and assume such liability and agree to protect, indemnify and hold the Rescue 4 All harmless from and against all of the aforesaid. Completing, signing and returning this document constitutes your permission for R4A to verify all information provided that you have provided and are attesting to as being true and correct.

Primary

Signature *

Date *

Spouse/Joint

Signature

Date

ALL parties agree that this application can be executed by the applicant and sent to Rescue4All via hand delivery, US Mail, Federal Express or any other recognized overnight delivery service or by email. If the applicant would like to send the document via email, applicant and the Rescue 4 All both agree that the applicant’s digital signature is valid and binding upon the parties.

Thank you for contacting Rescue 4 All. We look forward to working with you.

WE RESERVE THE RIGHT, IN OUR SOLE DISCRETION, TO REFUSE ANY APPLICANT FOR ANY REASON WHATSOEVER.

If you need more space or have any additional information, comments, etc please type below:

THANK YOU FOR HELPING R4A KEEP THE LIVING

ALIVE!

**Fields marked with an "*" are required and your application will not submit if the field is not completed

If you have difficulty with this application please email adoptions@rescue4all.org.