Eddy s K9 Rescue Adoption Agreement CURRENT GUARDIAN INFORMATION: Name: Eddy s K-9 Rescue Phone Number: 305-510-1928 BASIC ADOPTED ANIMAL INFORMATION: Select One: Cat Dog Other If Other, Specify: Pet s Name M/F Age: Date Of Birth (If Known): Breed: Color: Other Information (If Known): Animal Microchip #: Animal ID #: Adoption Fee Initial ADOPTER INFORMATION: Name: Address: City: State: Zip Phone Number: Cell: Email: Driver s License Number: Adopters Signature: X 1
ADOPTER BASIC/HOUSE INFORMATION: Place Of Employment: Number Of Adults In Household And Age(S): Number Of Children In Household And Age(S): Do You Own or Rent Your Home? o If You Rent, Do You Have Landlord s Permission to Have a Pet? Y/N Do You Have A Fenced In Yard? Y/N Number Of Years At Current Address: If you are a renter or live in a condo, does your landlord/association allow dogs? Name of Landlord Phone What would you do if you moved to a residence where dogs are not permitted? Are all members of your household in agreement about adopting a dog? Is anyone in your household nervous or unsure around dogs? Who will be the primary caregiver for this pet? For whom would you be adopting this dog? Who will be financially responsible for this animal? Are you willing to have all members of your household come to meet the pet(s)? Do any of the members of your household have asthma, or allergies to dogs? Describe your household activity/noise level? How often do you travel? How will you care for your dog when you are away from home? In the event of an emergency, who would care for your dog or what arrangements would you make? For how many hours would the dog be alone during the day? 2
CURRENT PET INFORMATION (If Any): List All Current Pets: Are All Of The Above Animals Currently On Or Have Previously Gotten: o Vaccinations: Y/N o Heartworm Prevention: Y/N o Flea/Tic Prevention: Y/N o Spayed/Neutered: Y/N If You Did NOT Answer Yes To All of the Above Questions, Please Explain: If you have other pets do they get along with other dogs? Have any of your current dogs been exposed to parvo or distemper? What veterinary Hospital do your pets go to? Address: City: State Phone Are you experiencing any difficulties with your current pets in terms of health or behavior? If Yes, Describe 3
PET HISTORY: Have all your family members been around dogs? Have you had the experience of being a primary caregiver to a dog? Have you ever given a pet away, given it to a shelter or rescue group, returned it to a breeder or sold it? Explain: Have you ever had a pet for a short period of time an it didn t work out? Explain Have you ever had a dog lost or stolen? Explain Have you ever had to retrieve your animal from a pound, shelter or animal control facility? Explain Have you ever had an animal die as a result of being hit by a car, being poisoned or from unknown causes? Have you had a dog that gave birth? Have you previously applied to adopt from us? 4
PLANS FOR YOUR NEW PET Where will the dog live? Indoors Outdoors Not Sure Where will the dog be when nobody is home? Indoors Outdoors Not Sure Do you have a fenced yard? What veterinary practice do you plan to use? If you adopt a pet that is not spayed/neutered, do you Intend to have it spayed/neutered Intend to let it have puppies Not Sure Are you aware that some dogs require a period of weeks or even months to adjust to their new home/environment/family/other pets? Are you willing to allow for this adjustment period? Yes No, prefer a pet who will adjust quickly Not Sure Are you willing to bring you pet to a veterinarian for yearly exams, and for vaccinations per your vets recommendation? Are you able/willing to pay for emergency care, which could result in a bill of $200 to $1000 or more? Are you able/willing to pay for pet expenses including vet care, supplies, toys, boarding/pet sitting, grooming, food, etc? 5
Are you able to commit to providing a home for a dog for the rest of his/her life? What circumstances might justify giving up a dog? (check all that apply) Baby Divorce Moving Allergies Shedding Destructive Too Time Consuming Want to Travel Behavior Problems Dog Becomes Ill Children Lost Interest House Soiling/Urine Marking New Household Member Dislikes Dogs None Other If your dog exhibits behavioral or adjustment issues, would you be willing to seek the advice of Eddy s K9 Rescue Representative? Would you be willing to pay for obedience or behavioral sessions? PREFERENCES: Check all that apply Adult Senior Puppy (Up to 1 year) Male Female Spayed/Neutered Indoor Only Indoor/Outdoor Outdoor Mellow/Quiet Lap Dog Protective 6
Very Active/Energetic Mainly an Outdoor Dog Hypoallergenic Likely to be housetrained I prefer a dog that is Small Medium Large Any Reason for adopting Companionship Watchdog Other Energy level preferred High Medium Low Breeds/Mixes I prefer My ideal dog is Bad doggie habits I cannot tolerate Please provide three personal references: Name Phone Name Phone Name Phone I AGREE THAT ALL STATEMENTS I HAVE MADE ON THIS FORM ARE TRUE. IF IT IS FOUND THAT ANY STATEMENTS HAVE MADE ON THIS FORM ARE NOT TRUE THE ADOPTED ANIMAL CAN BE CONFISCATED. IT IS ACKNOWLEDGED THAT THIS APPLICATION SHALL BECOME PART OF THE ADOPTION CONTRACT AND FALSE INFORMATION GIVEN ON THIS APPLICATION CAN LEAD TO US TAKING ANY NECESSARY STEPS TO VOID THE TERMS OF THE ADOPTION CONTRACT RESULTING IN THE IMMEDIATE SURRENDER OF THE ADOPTED PET, UNDER THE TERMS SET FORTH IN THE CONTRACT. ADOPTER IS TO PAY ANY AND ALL RELATED EXPENSES, LEGAL AND OTHERWISE. Adopter s Signature Date 7
ADOPTER S AGREEMENT: (If Animal Is Not Spayed/Neutered At Time Of Adoption) I Agree That I Will Have The Animal Spayed/Neutered At The Appropriate Time By The Humane Society Or My Own Private Vet At My Cost And Responsibility. Vaccines must be done within 7 days of adoption. (Initial) I Agree That The Animal Is Being Adopted For Myself And Will Not Be Sold, Adopted, Or Given To Another Party. (Initial) I Agree That The Animal Will Not Be Allowed Outdoors Without Proper Supervision. When Taking My Cat/Dog Outdoors, They Will Be On A Secure Harness And Wear Proper Id. (Initial) (If Adopting A Dog) I Agree That This Dog Is To Be A Companion Animal, Not A Guard Or Fighting Dog. The Dog Will Live Inside My Home, Not Outdoors. (Initial) I Agree To Care For The Animal In A Humane Manner And Be A Responsible Animal Guardian. This Includes Supplying Adequate Food, Water, Shelter, Attention, And Medical Care. (Initial) I Agree That If At Any Point I Cannot Keep The Animal, I Will Return Him/Her to Eddy s K9 Rescue Without Requesting A Fee. (Initial) I Understand And Agree That Eddy s K9 Rescue Makes No Guarantees About The Animal's Temperament And Is Not Responsible For Future Damages Or Injuries Caused By The Animal. (Initial) I Give Eddy s K9 Rescue The Right To Inspect My Home Or Call My Home At Any Reasonable Time, Without Notice; To Assure That The Animal Is Being Properly Treated And Cared For. (Initial) I Agree To Keep Eddy s K9 Rescue Informed Of My Current Home Address And Phone Number. (Initial) I agree that under NO circumstances is this dog to be euthanized for any reason without first contacting Eddy s K9 Rescue. Eddy s K9 Rescue will make the final decision on euthanization of any of our dogs and will only be considered in extreme circumstances as determined by Eddy s K9 Rescue. (Initial) I Agree By Taking Possession of This Animal All Liability of The Dog Is Transferred from Eddy s K-9 Rescue to Myself. (Initial) 8
RESCUE GROUP ONLY Completed Home Check: Y/N Notes: Rescuer Signature: X 9