Tobie s Small Dog Rescue

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1 Tobie s Small Dog Rescue Which Dog are you inquiring about? We believe that adopting a dog is a commitment for the lifetime of your companion animal. We appreciate your willingness to complete this form so that we can learn more about you, your family and home environment. Your Info First Name* Last Name* Birthdate* Address* City* State/Province* Zip/Postal Code* Home Phone* Work Phone* Cell Phone* * Names and ages of all people living in your home and their relationship to you. If you have children please list ages: Your Home

2 Type of dwelling you live in* House Condo Apartment Do you own or rent your home? If you rent, please include the name and phone# of your landlord. \ Do you have a fenced in yard? If no, please explain how you will handle toilet duties and exercise: Do you have a pool? * Your Pets I agree that this animal is being adopted as a family pet, and will be given extensive house privileges; i.e. to sleep inside the house, to be allowed freedom of the house when the family is home, and NOT to be restricted to the yard* (Initial)* Do you currently own another pet? * If so, please list; Names: Breeds: Ages: Neutered/spayed? If your pet became ill, gets injured, needs surgery, needs ongoing medical care, etc., how will you manage Veterinarian Facility s Name: Veterinarian s Name:

3 Phone* Do you give us permission to contact your vet? * Your New Dog Who will be primarily responsible for this pet? * On average, how many hours a day will this pet be left alone? * If the pet will be left alone for long periods of time, where do you plan to keep this pet while you are gone? * Where will this pet sleep? * Are you willing to accept the responsibility of housebreaking this pet, if it isn t completely housebroken? Are you prepared to ensure that this pet receives regular veterinary care? * Under what circumstances would you not keep this pet? * Your Acknowledgments I acknowledge and agree that Tobie s Small Dog Rescue is not responsible or liable for any injury, damage, or harm caused by this pet. * (initial) If I can no longer keep this pet, I will contact Tobie s Small Dog Rescue exclusively and ASAP to retrieve it, no questions asked (unless evidence of illness or injury*. (Initial) Adoption Fees range from $ $ per pet.

4 I understand that the adoption fee is nonrefundable. (Initial)* I understand that to the best of my knowledge this pet is in general good health, with the sole exception(s)* Notwithstanding the forgoing, TSDR makes no representations and/or guarantees as to the age, temperament, and/or health of this pet. * (initial) Signature(s)* X X Date* Please let us know how you heard about us:

5 Puppy Adoption Disclaimer Thank you for choosing to adopt a puppy from Tobie s Small Dog Rescue. We rescue abandoned puppies, sometimes along with their mothers, from shelters throughout California. We pride ourselves in providing a safe and loving environment for these pups and moms while they are readied for the adoption process. Our pups are completely vetted, given their first round of vaccines, as well as microchipped before they are listed for adoption. Our adoption fees for puppies range between $350-$400 which covers their spay or neuter. It is the law in Los Angeles that all dogs must be spayed/neutered by the age of 6 months. We are obligated to show proof of spay/neuter to the shelters where the pups came from. Failure to do so in a timely manner could result in the revocation of our rights to rescue. We here at Tobie s Small Dog Rescue take the law and our rights very seriously. We follow up with every adopter with a phone call during the time it is necessary to return to our clinic for spay/neuter. We provide all the necessary info about the clinic and we give each adopter a 2-week window to comply. This is a mandatory rule of adoptions of puppies from Tobie s Small Dog Rescue. By signing this agreement, you are acknowledging that you have read the above paragraph thoroughly and have a full understanding of its content. Thank you for your cooperation. X Adopter Date X Adopter Date X Witness

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