COLLAR Inc. Adoption Application Form

Crazy Old Lady Loving Animal Rescue, Inc. (COLLAR) Foster/Adoption Application

Perspective Pet Parent*

First NameLast Name

Name of Pet You Wish to Adopt*

Email Address*

Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Do you have any pets?*

Pet Name(s)

Pet Breed(s)

Current pet's disposition and behavior towards dogs?

Please provide your veterinarian's name and phone number:*

Do you own or rent your home?*

OwnRent

If you rent, please provide your landlord's information here:

Do you have a yard?*

YesNo

If "Yes" to the above, is it fenced? please describe

Have you ever surrendered a pet you own to any animal shelter including a "low" or "no kill" shelter?*

YesNo

Are there children in the home? (If yes, please list ages)*

How many hours per day would the pet be alone?*

Will you crate your pet?*

If you have to leave town, unplanned or planned, where would your pet stay?*

How would you describe your lifestyle - we have a dog for everyone - couch potato, hiker, boating?*

How would you deal with behavioral issues such as barking, chewing, destructive behavior, bathroom accidents indoors, unruly leash behaviors in your pet?*

Please provide the names, emails, and contact numbers for 2 personal references:*

Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment?*

YesNo

If you answered "Yes" please provide a detailed description:

By clicking the submit button, I agree to Crazy Old Lady Rescue (COLR) adoption process, will undergo a homecheck, and interview at the discretion of Linda Lang
By clicking the submit button, I understand (COLR) will check my references including veterinary and personal.
By clicking the submit button, I understand there is no "cooling off" period, and that if I no longer want or can no longer care for my adopted pet, I agree to notify (COLR) immediately. You and Linda will coordinate arrangents for the pet to be taken back into rescue.
By clicking the submit button, I agree to indemnify and hold harmless (COLR) against any losses, lawsuits, claims, injury, damages incurred by me or to any persons or property by my adopted pet, once adoption has been completed.
By clicking the submit button, I understand that (COLR) will disclose any of the pet's health or behavior issues before adoption is completed.
By clicking the submit button, I verify all of the above information is true and accurate.

Signature of Potential Pet Parent*