Pet Adptin Applicatin Dg name: Gender Clr Cntact Infrmatin Street Address City / ST / ZIP Cde Hme Phne Wrk Phne Cell Phne Persnal Reference 1: Phne Prperty Type: Apartment Cnd / Twnhme Duplex Huse Mbile Hme Other: Prperty Infrmatin D yu: Own Rent Pets Permitted:
Duratin at this address: Lease Renewal Date (if applicable) D yu plan t mve in the near future? Anticipated new living arrangements? (if applicable) Landlrd Infrmatin (if applicable) Phne Husehld Infrmatin: Hw many adults reside in the husehld? 1 2 3 4+ Are there children in the huse? (if s, please list their ages) Ages: Is anyne in the husehld allergic t animals? Des anyne in the husehld suffer frm asthma? Pet Histry Have yu wned a pet befre? Pets Owned in past 5 years: Pet Type / Breed Age Spay / Neutered Current n vaccinatins? Inside r Outside Pet Status
Pet Care Veterinarian Infrmatin (if wn pets currently) / Practice Phne Are yu financially able t vet a pet shuld it becme ill? ($100 - $500) Are yu prepared t allw a 2 week minimum fr pet adjustment t yur hme? Are yu cmmitted t prviding a respnsible hme fr the pet up t 15 years r mre? Wh will be the pets primary caregiver? (rle in husehld & age) Where will pet stay during the day? Where will pet stay during the night? Where will pet stay while caregiver is away frm hme? Hw many hurs will the pet be left alne? Are yu aware yur new pet may need husebrken? Wuld yu like infrmatin n hw t huse train yur pet? Are yu familiar with: Leash laws in yur cmmunity? Licensing laws in yur cmmunity? Heartwrm disease? Is yur yard fenced? Puppy & Dg Adptins Only Yes N Is there a lck n the gate? Hw will yur dg be cnfined t yur prperty (check all that apply)? Chain Electric Fence Fenced Yard Garage Huse Leash Kennel Pati Runner
Pet Adptin Infrmatin & Plicies The animals available fr adptin came t Rags t Riches frm a variety f surces and backgrunds. In sme cases, their past histry is unknwn. Adptin fees include the first series f vaccinatins (fr puppies this includes a series f (3) shts). These vaccinatins include rabies and de-wrming. Heartwrm testing and Feline leukemia / aids testing are dne as applicable. Adptive wners are required t keep the pet current n all vaccinatins fllwing adptin. Please read the fllwing carefully and indicate yur agreement by initialing each line: As an adptive parent f the Rags t Riches Animal Rescue, I understand and agree t the fllwing. I understand that the spaying / neutering f my pet is a cnditin f this adptin and that I am respnsible fr the cst f the prcedure. A depsit, equal t the adptin fee, will be prvided t the Rags t Riches Animal Rescue. This check will be held and will nt be cashed. Once dcumentatin is prvided that the prcedure has been cmpleted, the depsit will be returned. I agree that I will have the pet spayed / neutered n mre than 30 days after the pet reaches the age f 6 mnths. I understand that if I fail t prvide the necessary dcumentatin by the time my pet is (6) mnths f age, the depsit check will be cashed and the adptin is null and vid. The pet will be returned t Rags t Riches Animal Rescue. If Rags t Riches can arrange fr the spay / neuter f my pet, I agree t make all the scheduled appintments arranged n my behalf and prvide dcumentatin t this effect. Initials: I agree that if fr any reasn this adptin des nt wrk, I will cntact Rags t Riches Animal Rescue and make arrangements t return the pet t them AND ONLY them with the understanding that there is a N Refund plicy. This ensures they will find a permanent hme with suitable accmmdatins, respnsible wners and that the pet will nt be euthanized. Initials: I agree t prvide the prper fd, water, adequate shelter frm the elements and kind treatment at all times. Initials: I agree t take my adpted pet t the vet fr annual vaccinatins, checkups, and will keep them n heartwrm preventin. Shuld my pet becme ill r injured, I will seek immediate veterinary care. Initials: I agree I will nt use the pet fr hunting purpses. Initials: My pet will be in a fenced yard, n a leash r n a large acreage tract. They will never be tied. The pet will preferably be inside, but will ALWAYS be inside if there is excessive heat r cld (abve 85 degrees r belw 32 degrees & during strms). Initials: I agree that a Rags t Riches Animal Rescue representative can make an unscheduled visit after adptin t ensure the pets well being. If it is deemed the pet is nt being well cared fr, Rags t Riches Animal Resue may enter my prperty fr the purpses f taking pssessin f the animal. Initials: I agree that Rags t Riches Animal Rescue can nt guarantee the health, temperament, r training f the pet listed and agree t release Rags t Riches Animal Rescue frm all liability nce the animal is in my pssessin. Initials: It is my hnest intent t give this pet a frever hme. Initials:
I have been prvided a cpy f these plicies & read these statements and understand the rights and bligatins invlved in this pet adptin, Initials: Agreement and Signature By submitting this applicatin, I affirm that the facts set frth in it are true and cmplete and represents my understanding and agreement t the abve plicies. (printed) Signature Date Our Plicy Rags t Riches reserves the right t refuse adptin t anyne. N animal will be adpted t prspective wners wh mislead r fail t prvide accurate infrmatin n the adptin applicatin. If the cnditins f this cntract are nt met the adpted will pay all curt csts and fees. If the animal is ut f state, the adpter will restre and send animal back t Rags t Riches at the adpters expense. Thank yu fr cmpleting this applicatin frm and fr yur interest in adpting with us.