The Lucky Lucy Foundation CANINE ADOPTION CONTRACT FOR 2019 Thank you for your interest in adop$ng a rescue canine instead of suppor$ng irresponsible breeders and pet shops. The document must be completed in black ink and all pages of this contract must be ini$aled and the last page must be signed and dated. Once completed, please return the contract to adop$on@luckylucy.org. 1. ADOPTION TERMS AND CONDITIONS In order to be considered for an adop$on, you must: Be at least 18 years of age, Have the knowledge and consent of all other par$es staying in the same household you want to adopt the dog/ puppy to. Have the necessary consent of a landlord if you are ren$ng. Be self-sufficient and have the financial means to support the animal in terms of feeding and medical expenses. 2. 3. 4. Animals cannot be adopted as gi<s for family members, friends or children. Parents will have to be primary care takers un$l such $me as a child is able to responsibly care for the animal. We will only consider the adop$on of puppies and juveniles between the ages of 0 12 months to persons not older than 55 years of age. The Lucky Lucy Founda$on reserve the right at any $me during the adop$on process to decline an applica$on, without explana$on. 5. All adop$on applica$ons are subject to a home check performed by a person appointed by the Lucky Lucy Founda$on. 6. 7. Young puppies have low immunity, and the stress of joining a new home can some$mes lead to stress related symptoms like diarrhea or lethargy. Do you agree to take your new puppy to the vet as soon as possible, should any of these symptoms affect its health? Disclaimer: Whilst every effort is made to ensure that all dogs and puppies adopted out have tested nega$ve for Parvovirus and Distemper we cannot be held responsible for the virus that is in the incuba$on period of up to 14 days for Parvo and 35 days for distemper. CANINE APPLICATION FOR (please complete the name(s)) DOG (1 year and older) SPECIAL NEEDS (any age) PUPPY (1 month 12 months) RETIREE (7 years and older) PERSONAL INFORMATION Applicant InformaGon Full Name & Surname Iden$ty Number Cell Number Home Tel number Spouse/Partner InformaGon Full Name & Surname Iden$ty Number Cell Number Rela$onship Page of 5 1
PERSONAL INFORMATION Home Address (Physical) EMPLOYMENT INFORMATION FOR THE APPLICANT Employer Working Hours Occupa$on Office Tel Number Business Address RESIDENCE / ACCOMMODATION INFORMATION Residence Type (*Please mark ALL the appropriate block(s)) Freestanding House House in a Security Complex Apartment Duplex Small Holding Living with parents Rented Property Own Property In the case of a rented property do you have permission to keep animals on the property? Do you have a pool/ large pond and is it covered or open? Covered Open Fenced Is your property/ complex fenced? Type of Fencing? Vibracrete Steel Electric Wood Mix Other Is the property close to a main road? What is the size of your property? No Yard Small Medium Large More than 1 Hectare Is the volume of traffic in your street? Heavy Light Moderate The noise/ac$vity level in your home is usually? High Medium Low FAMILY MEMBERS and OTHER MEMBERS CURRENTLY LIVING WITH YOU Do you have Children? Other Family members or housemates currently living with you? Name Age Known Allergies Name Age Known Allergies Page of 5 2
INFORMATION ABOUT YOUR CURRENT PETS IN THE HOUSEHOLD Name Age Type of Animal (Dog/Cat/Bird etc.) Breed Sterilised Yes / No Time in your Care Vaccina$ons up to date Yes / No MORE INFORMATION ABOUT YOUR CURRENT PETS IN THE HOUSEHOLD Where do your pets stay when you go on holiday? Boarding Kennel Friends or Family @ Home Get a Petsiier Take them with Have you ever surrendered any of your pets to a shelter (past 10 years)? Have you ever rehomed any of your pets (past 10 years)? If so, please give short If so, please give short Have any of your pets got lost recently (past 24 months)? Have any of your pets died recently (past 12 month)? If so, please give short If so, please give short YOUR VETERINARIAN S INFORMATION Prac$ce Name Vet s Name Business Tel number Business Address (Physical) Page of 5 3
INFORMATION NEEDED FOR THE NEW ADOPTION PROCESS? Have you ever had an adop$on applica$on rejected by another organisa$on? If so, please provide What temperament and ac$vity level you are looking for in a dog/puppy companion(check all that apply): High Energy Lap Dog Mellow Affec$onate Quiet Does not maier Why would you like to adopt a dog/puppy? Epol Bob Mar$n Canine Cuisine Hills Royal Canin Eukanuba Pedigree Bobtail What food will your dog/ puppy be ea$ng? Montego RAW Acana Orijen Other Please give more details :. Where will your dog / puppy stay / sleep? Only Inside Only Outside Outside & Inside On average how long will your new dog/ puppy be lem alone during the day? INFORMATION NEEDED FOR THE NEW ADOPTION PROCESS Between 0-5 hours a day Between 5-10 hours a day Longer than 10 hours a day Would you be able to provide a scratch pole for your dog/puppy? Have you ever had a dog debarked? I prefer a dog/puppy that : (check all that apply) Loves children and strangers Can tolerate children and strangers Loves other animals Can tolerate all other animals Loves birds I don t care if he/she gets along with other animals, children or strangers Chewing my furniture or rugs Soiling in the house List the type of behavioral problems you consider not acceptable (meaning you wouldn t be willing to work on) to keep the dog/puppy? Aggression towards people Urine Marking Aggression towards other animals in the household Fear Stress Dogs that jump up Dogs that dig Dogs that wake you up at night or too early to play NONE SURVEY (Thank you for your -me) Do you want to subscribe to our Newsleier? Already subscribed YES, please NO, thank you Facebook Internet (WEB) Networking through email Where did you hear about the Lucky Lucy Founda$on? From a Friend/Family/Colleague Other Please give more detail : Page of 5 4
DECLARATION I hereby declare that all the informa$on provided in this contract is true to the best of my knowledge and belief. In the case where any of my current pets are not sterilised, I hereby agree to sterilise them prior to accep$ng the new dog/puppy into my home. I agree to pay the adop$on fee of R700 or as determined by LLF either up front or upon collec$on of my new dog/puppy. I also agree to the condi$on that the adop$on fee is non-refundable and that it will be considered as a dona$on to LLF upon return of my newly adopted animal. I agree that the Lucky Lucy Founda$on can provide my newly adopted dog with a microchip which will be registered in the name of the Founda$on. I agree to inform the Lucky Lucy Founda$on within 7 working days in case any of my contact details (including physical address) should change. I hereby declare that I will not use the animal in any illegal ac$vi$es. I hereby agree that if I ever need to relinquish the animal during its life, that I will contact the Lucky Lucy Founda$on for its surrender. I hereby declare that I will never sell, give the animal away or hand it down to another family member or individual or any other welfare organisa$on (including the SPCA and AACL). I hereby agree that I will be responsible for ALL medical expenses, which include emergencies, rou$ne procedures, annual check-ups, vaccina$ons, and all other medical expenses that might occur. I hereby agree to allow the Lucky Lucy Founda$on permission to do unannounced follow-up home checks for the life$me of the adopted animal. I agree that the Lucky Lucy Founda$on has the right to confiscate any adopted animal at any $me without approval and their discre$on, should maiers arise that contradict the agreement of the adop$on contract. I agree that this document is considered a legally binding contract between the Lucky Lucy Founda$on and myself. Signed on this day of 2019 at. Signature of Applicant *Please ensure that all pages of this Adop-on Contract are ini-aled and the last page signed. Electronic Funds Transfer InformaGon or Cash when fetching your new friend: The Lucky Lucy Founda$on Standard Bank Cape Gate Branch Code: 023910 Cheque account 410514039 Page 5 of 5