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Merlin's Hope Chow Chow & Chinese Sharpei Rescue http://www.chowrescue.get2.us http://rehomemychow.wordpress.com Adoption Application Form EMAIL THIS COMPLETED FORM TO: millsmontreal@gmail.com or FAX to: 514-683-0522 Page 1 of 5 This adoption agreement is made this date, ________________, between Merlin's Hope Rescue., a volonteer DOG RESCUE, an entity with its principal place of business in Toronto, Ontario, (hereinafter known as RESCUE) and _______________________ (hereinafter known as the ADOPTER) for the adoption of the dog identified below (hereinafter known as RESCUE DOG): Name of Dog Nom de Chien Sex Age Male Female Breed - Race Colour - Couleur Coat Type: Other Marks – Autre marques Merlin's Hope Chow Chow & Chinese Sharpei Rescue http://www.chowrescue.get2.us http://rehomemychow.wordpress.com Adoption Application Form EMAIL THIS COMPLETED FORM TO: millsmontreal@gmail.com or FAX to: 514-683-0522 Page 2 of 5 The terms of the adoption of RESCUE DOG are listed below: ADOPTER will pay RESCUE an adoption fee of $__300.00________ at the time of the actual the adoption of RESCUE DOG, (or before). $_____0.00_____ is due upon signing of the contract. however, dog is not being held. 1: ADOPTER is encouraged to have a licensed veterinarian of its choice examine RESCUE DOG within 48 hours of adoption. If, within 48 hours of adoption, RESCUE DOG is found to be unhealthy, ADOPTER may return RESCUE DOG to the RESCUE for a refund of any portion of the adoption fee paid. Otherwise, ADOPTER accepts full responsibility for the health and temperament of RESCUE DOG. No refunds or reimbursements will be made by RESCUE for any costs incurred by ADOPTER, e.g., food, leash, collar, veterinarian bills, etc. If at any time and for any reason, the ADOPTER cannot, or chooses not to, keep RESCUE DOG, RESCUE must be notified immediately. RESCUE will take RESCUE DOG to re-adopt it. The return of RESCUE DOG to the adoption center will be at the expense, responsibility and liability of ADOPTER. 2: ADOPTER agrees that it will not find RESCUE DOG a new home without approval of RESCUE. All potential adoptions must take place through RESCUE. Except as provided in paragraphs 1, above, no portion of the adoption fee will be refunded, nor will any costs incurred by ADOPTER, e.g., food, leash, collar, veterinarian bills, etc., be reimbursed by RESCUE. 3: ADOPTER understands that the temperament, pedigree, and health of RESCUE DOG are not, or may not be, fully known, and does hereby assume full responsibility for any and all actions of, and for any and all personal injuries and/or damages that may be caused by, RESCUE DOG. The ADOPTER agrees to indemnify and hold harmless RESCUE from any and all claims, damages, losses, fees or costs arising from or relating to any claims for personal or other injuries or damages caused by RESCUE DOG. ADOPTER also acknowledges that RESCUE cannot guarantee the health and longevity of RESCUE DOG and will be held harmless for any medical costs that arise from RESCUE DOG. Your Name Votre Nom Street Address Votre adresse City Ville Prov Telephone Email Courriel Applicant’s Employer: Votre place du Travaille Postal Code Code Postale Merlin's Hope Chow Chow & Chinese Sharpei Rescue http://www.chowrescue.get2.us http://rehomemychow.wordpress.com Adoption Application Form EMAIL THIS COMPLETED FORM TO: millsmontreal@gmail.com or FAX to: 514-683-0522 Page 3 of 5 Work Phone Téléphone au travaille Driver’s Liscence Number or other valid ID No Permis de Conduire ou autre identification valid Explain why you would like to adopt this dog? Pourquoi aimerz-vous adopter ce chien ? Your marital status: Etat Civil: Is your partner in agreement with this adoption? Si oui, Votre associé est-il d'accord avec cette adoption ? What type of experience to you have with dogs? Quel type d'expérience avez-vous avec des chiens ? Have you ever adopted a dog before? If yes from where? Est-ce que vous avez déjè adopté un chien ? Si oui d'où ? Do you presently have any pets at home? If yes, how many and what kind? Avez-vous d'autres animaux à la maison présentment ? Si oui quel genre d'animaux et combien ? Will the adopted pet be living with children? If so, what ages(s) and how many? Est-ce que le chien adopté vivra avec des enfants? Si oui, combines d’enfants et Quels sont leurs âge(s)? Do you have previous experience with this breed of dog? Explain Avez-vous une expérience précédente avec cette race de chien ? Expliquez What type of residence do you live in? (House appt, etc.) Dans quel type de résidence demurez-vous? (maison, appt) Any covenants or restrictions that prevent you from having a pet? If so - explain Engagements ou restrictions qui vous empêchent d'avoir un animal ? Si oui - expliquez Will the dog be alone all day? Le chien sera-t-il seul toute la journée ? Merlin's Hope Chow Chow & Chinese Sharpei Rescue http://www.chowrescue.get2.us http://rehomemychow.wordpress.com Adoption Application Form EMAIL THIS COMPLETED FORM TO: millsmontreal@gmail.com or FAX to: 514-683-0522 Page 4 of 5 Do you have a totally enclosed, secure yard? Avez-vous une cour totalement cloturée? What kind of fence? Quel type de cloture? Are you a member of any dog clubs or breed clubs? Êtes-vous membre d’un club de chien ou des clubs de race ? If so, please list the clubs that you are a member of: Si oui, indiquez les clubs en question: Will the dog be crated? If yes, for how many hours per day? Le chien sera-t-il dans une cage? Si oui, pendant combien d'heures par jour ? How do you plan to exercise the dog? Comment projetez-vous d'exercer le chien ? * Can we contact your vet Pouvons-nous contacter votre vétérinaire ? Vet name Nom Vétérinaire Vet phone Tél Vétérinaire By submitting this form you acknowledge and agree to the terms below Adopter, Foster Home agent or Volunteer being of lawful age, do now release, acquit and forever discharge Merlin's Hope Rescue, its Agents and Assigns, from any and all actions, claims, demands or damages accruing to me resulting from any known or unknown injury, loss or damage, sustained by me as a result of acting as a Merlin's Hope foster agent or volunteer. I affirm that I have not been convicted of any crime involving the mistreatment, neglect or abuse of any animal. I ACKNOWLEDGE THAT ALL THE INFORMATION CONTAINED ON THIS FORM IS TRUE AND CORRECT. I UNDERSTAND THAT ANY MISREPRESENTATIONS OF FACT MAY RESULT IN THE REMOVAL OF THE DOG FROM MY HOME Signature Merlin's Hope Chow Chow & Chinese Sharpei Rescue http://www.chowrescue.get2.us http://rehomemychow.wordpress.com Adoption Application Form EMAIL THIS COMPLETED FORM TO: millsmontreal@gmail.com or FAX to: 514-683-0522 Page 5 of 5 Date:_______________________ NB: For Quebec Residents: LANGUAGE: You and we have expressly requested that this Agreement and all related documents, including notices, be drawn up in the English language. Vous et nous avons expressément demandé que ce contrat et tout document y afférent, y compris tout avis, soient rédigés en langue anglaise. (Quebec only/Québec seulement) Bottom of Form
