Date (mm/dd/yyyy) :
Name and/or breed of the Pet you are interested in (if known) :
Driver License Number :
Name : (First, MI, Last)
Present Street Address:
City:
State:
Zipcode:
How Long have you lived at this address?
Are you planning to move in the near future?
If you do move, what will you do with your pet(s)?
Home Phone Number:
Cell Phone Number:
Work Phone Number:
E-Mail Address:
Are you over 18 years of Age?
Occupation:
How Long are you away from home each day?
Your Current Home Environment
Do you own or rent your home?
Type of Home you currently live in:
Pick One
House
Duplex
Apartment
Condo
Mobile Home
Other
Do you have a fenced yard?
Pick One
Wood
Chain Link
Vinyl
Other
The following questions only apply if you do not own your home:
Name of apartment complex, mobile home park or landlord:
Are Pets Allowed?
Please list any pet restrictions (i.e., weight, number of pets allowed, etc)
Have you notified them of your intention of adopting a pet?
Adopters who do not own their own home must have their pet registered on the home or apartment lease
Members Within Your Household
How many Adults live in your home?
How many children live in your home?
Do any members of your household have allergies?
Information of Current Pets
Please list all of the pets currently residing at the address listed above: (be sure of include the following:) Type of Pet (dog,cat,ferret, etc. Breed Male/Female Age of Pet
Are any of these pets kept outdoors?
Are all of these pets spayed or neutered?
If you answered No, which pets are not spayed or neutered?
Veterinarian Information:
Name of the Veterinarian you will be using for this pet
Veterinarian Address:
Veterinarian Phone Number:
Pet History
Have you had any other pets in the last five years that are not listed on this application?
If yes, list the Type of Animal,Sex,Age, Spayed/Neutered and what happened to them.
Have you adopted any pets from a rescue group or shelter in the past?
If yes, please list the name of the rescue(s) or shelter(s).
Where is this pet now?
Pet Specifics
What gender of dog are you interested in adopting?
Pick One
Male
Felmale
No Preference
What age of the pet are you interested in adopting?
Pick One
Adult (over 1yr to 3yrs)
Adult (over 3 yrs)
Older Puppy (5 mos - 1yr.)
Puppy (Younger than 5 mos.)
No Preference
What size dog are you interested in adopting?
Pick One
Toy (Under 10 lbs)
Small (11 - 25 lbs)
Medium (26 - 50 lbs)
Large (51 - 90 lbs)
Giant (Over 90 lbs)
No Preference
How active would you like your dog to be?
Pick One
Very Active (needs lots of exercise)
Active (needs moderate exercise)
Sedentary (couch potatoe)
No Preference
I want this pet for: While holding your Ctrl Button - pick all that apply
Pick all that apply
Breeding
Companion
Child's Pet
Hunting
Gift
Guard Dog/Protection
Work/Farm
Companion for other pet
Other
How long have you been looking for a pet?
My pet will live...... Live indoors - only goes outside for potty breaks and exercise Live outdoors - spends most of the day outside.
Pick One
Indoors
Outdoors
Undecided
Will you leave your pet outside while you are gone for short periods?
Will you leave your pet outside while you are gone for long periods?
Will you be using a tie-out or chain to secure your dog?
When your pet is left by itself, the pet will stay....
Where will your pet sleep at night?
How long will your pet be left by itself each day?
If you do not have a fenced yard, how will you keep your pet confined to your property?
List your personal reasons for wanting a pet:
Are you willing to allow a representative of our group to visit your residence?
Use this space for any additional comments you may have:
Please read all of the following before signing your initials in the space provided after each statement This is a binding contract
1. I the undersigned adopting party, understand and agree to the following terms and conditions of this contract in the acquisition of the above-described animal , hereinafter referred to as "pet":
2. To agree to return the pet to Hope Rescues if unable to keep the pet for any reason. To never abandon the pet, give to another person or surrender, sell, or give the pet to a shelter, pet dealer, or a laboratory.
3. To agree to notify Hope Rescues if the pet is lost or stolen and to make all reasonable efforts to locate the pet.
4. To agree to notify Hope Rescues in the event that the pet suffers a life threatening illness or injury, or if the pet is deceased.
5. To never allow this pet to be trained for or used for protection or as an attack pet.
6. To treat this pet as a family pet with affection and kindness, never subjecting this pet to neglect, abuse or cruelty.
7. To provide regular veterinary care, including annual shots, heartworm preventative, and parasite checks.
8. To always keep this pet within a fenced yard - not on a chain, or other restraint (unless being walked), or safely within the home.
9. To never leave the pet unattended in a yard fenced or unfenced
10. To never transport this pet unconfined in an open vehicle such as the bed of a truck or open jeep. Or in a vehicle with the window(s) down so far that the pet could fall or jump out causing injury or death
11. To regularly check the tightness of any collar. To affix any licenses and tags to the collar and to never leave a choke chain on the pet when not attended. The Adopter(s) shall comply with all state / local ordinances regarding pet licensing, identification and restraint.
12. To notify Hope Rescues of the pet's annual progress
13. To notify Hope Rescues if I move
14. To allow Hope Rescues to periodically check on this pet.
15. To contact Hope Rescues, a veterinarian, or an obedience trainer when problems arise so that the problem may be eliminated or alleviated.
16. That any pet over the age of 6 months and not altered prior to adoption, must be altered within 1 month of this signed contract. And that any pet less than 6 months of age must be altered when they reach 6 months of age.
17. I authorize my vet to release pet information to Hope Rescues
18. In the event that adopter breeches contract in such a manner that Hope Rescues cannot reclaim the pet. Adopter will be responsible for reimbursing Hope Rescues for all cost related to the care to the pet above the original adoption fee.
I further understand and agree that 1. Non-compliance with any of the above terms and conditions may result in the immediate forfeiture of the pet and that Hope Rescues may reclaim this pet without payment of compensation to me/us.
2. Hope Rescues has advised me/us that the pet can sometimes dig, chew, soil, and exhibit other undesirable traits unless properly supervised, confined, and trained.
3. Hope Rescues has advised me that this pet may have been neglected, mistreated, or abused and that special care or precautions may be required.
4 . Any notices required to Hope Rescues required by this contract will be sent first class mail
5. I also am aware that if, for any reason, that I am unable to keep this pet, whether voluntary or involuntary that I may not receive a full or partial refund of my adoption fee.
6. In consideration of the adoption of this pet, I agree to assume full responsibility for the conduct of this pet upon the date of which I take the pet home. I further agree to hold harmless Hope Rescues and any individuals associated with Hope Rescues and to indemnify such organizations or individuals for any damages or costs resulting from liability, known or unknown, anticipated or unanticipated, as a result of the pet's conduct after the date of this agreement. I agree to accept responsibility for any and all future costs incurred for treatment or prevention of any illness in the pet. I understand that the pet may have been exposed to any infectious disease.
7. By submitting this application electronically I certify the information I have provided is correct, and further understand that Hope Rescues may refuse to adopt to any applicant for any reason. Hope Rescues is not obligated to discuss the reason for denial with applicant. I authorize Hope Rescues to investigate all statements and references in this application.
Your Name
Date