Adoption Contract - Rescue Me-Purebred K9 Rescue_ Inc

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Adoption Contract - Rescue Me-Purebred K9 Rescue_ Inc Powered By Docstoc
					                        Rescue Me-Purebred K9 Rescue, Inc.
                               of Central New York
                     Mary Cooper, Executive Director – (315) 271-6161
                     Sue Sitts, Adoption Coordinator – (315) 750-9675

As a non-profit animal welfare group, our goal is to promote responsible animal care and prevent
the abuse and suffering of companion animals. We will personally screen applicants in order to
determine if the needs of a specific rescue animal fits the lifestyle expectations of the potential
owner. This method has proven successful to save more homeless or relocating animals and
reduce the risk of failed adoptions. Completing this application does not guarantee adoption
approval. You must be 19 years of age or older to adopt one of our puppies/dogs. Please
complete this application and return via email or US mail. Allow us at least three business
days to process this information and contact your references. We will be contact you during this
process concerning any questions we may have. Your patience is greatly appreciated! (Use back
of sheet if needed.)

Today’s Date:

Name, ID#, or Breed(s) of dog you with to adopt:

Your Full Name:                                                      DOB:

Spouse/Roommate’s Name:                                              DOB:

Street Address:

City/State/Zip Code/County:

Home Phone:                                            Cell Phone:

Email Address:

Your Occupation:                                              Work #:

Spouse/Other’s Occupation:                                    Work #:

Do you? Own             Rent            Military Housing             Other

How long have you resided at your current address?
If less than one year, please give previous address:

If renting, landlord’s Name & Phone #:
If renting, we will need a statement from your landlord giving his/her permission for you to
have at dog at the above address.
Are you planning to move soon?               If yes, when and where?

Check which best describes the area in you live: Urban/City:              Rural/Farm
Check type of home: Single Family          Apartment:                Mobile Home:

Does anyone in your home have known allergies? If yes, please explain

Number of children residing in the home:        Ages:
Adults residing in the home:             Relationship:
Are all members of household in agreement to adopting a dog/puppy?
Do all members of the household work? Yes              No
How many hours will the dog be home alone?

List any pets currently living in your home:
    Pet’s        Dog/Cat   Age   Spayed/    Inside/     Where did you acquire this   # of Years
    Name            ?      Sex   Neutered   Outside/              pet?                 Owned

**If you have any additional pets, please list them on a separate, attached sheet of paper.

Name of Current and/or Past Veterinarian(s):

Vet’s Phone #:                                         # of Years Known:

  Please notify your veterinarian that we will be calling so they will release information.

What type of dog are you looking to adopt: Indoor/house:              Outside:       Gift:
Child’s:      Hunting:         Companion for other dog/cat:                 Protection:

Rate the activity level of your home: Quiet:            Busy/Frequent Visitors:
Active family with kids:              Very busy/sometimes hectic:

Is this your first experience with a dog? Yes      No
If yes, have you researched dog and/or puppy care? Yes                  No

Do you have a fenced in area for the dog/puppy? Yes          No       Size:
If no, which of the following do you plan to use? Electronic Fencing:       Tie Out:
Cable Runner:            Chain/Dog House:        Garage:        Outside Kennel:
Run Free:

Do you know how to crate train a puppy/dog? Yes                 No
Do you know how to housebreak a puppy?      Yes                 No

      When you are home, where will the dog be kept? (i.e. kitchen, living room, bedroom,
       laundry room, basement)
      Where will the dog/puppy sleep at night?
      When no one is home (i.e. work, shopping), where will the dog be kept (be specific)

      What arrangements have you made for the dog while you are away or on vacation?

      Are you familiar with canine heartworm disease and preventative? Yes          No
      Are you familiar with Animal Control ordinances and required licensing in your
       area? Yes          No
      Have you ever taken a dog to obedience classes?           Yes       No
      Are you planning on taking this dog/puppy?                Yes       No
      Do you understand the financial cost of owning a dog?      Yes      No
      Are you taking this dog/puppy for a vet visit within       Yes       No
       one month of the adoption?
      Are you familiar with introducing your new dog to         Yes        No
       the children & current pets residing in your home?
       (Dogs may experience stress or confusion in their new environment, please be
       patient and give the dog time to adjust.)
      Would you agree to a “home visit” by a volunteer to your home prior to and/or
       after adoption (by appointment only)? Yes            No
      Puppy Adopters – you will be legally obligated to have the puppy spayed/neutered
       by the age of 6 months and provide us with a copy of the spay/neuter certificate for
       our files. Are you willing to comply? Yes            No

References: Please list at least three references that are familiar with your family and
lifestyle (only one relative please).

Name:                                              Relationship:
Address                                            City/State/Zip
Phone #:                                           Cell #:

Name:                                              Relationship:
Address                                            City/State/Zip
Phone #:                                           Cell #:

Name:                                              Relationship:
Address                                            City/State/Zip
Phone #:                                           Cell #:

  Please take a moment to review your application. Missing or unclean information may
                               delay or prevent approval.

I have read the above information carefully and have filled out this application to the best of my knowledge. I
understand that omission of information and/or failure to answer all questions honestly can result in this
application being declined. I give “Rescue Me” and its associates’ permission to fully investigate the information
provided, as well as contact veterinarians and related persons and officials. In addition, I understand the
adoption decision is dependent on many factors, including but not limited to, the compatibility of the family and
home to the individual animal, and other applications received on this animal.

By signing this contract, I attest and swear that all information is accurate and true to the best of my knowledge
and that I have never been charged or convicted of animal abuse, neglect or maltreatment.

All dog adoption contracts approved by Rescue Me–Purebred K9 Rescue, Inc., are subject to the following terms and conditions:
1. The Adopter (herein known as the individual adopting the said name dog) agrees that the dog will be kept only as a
     domesticated house pet. This means that the dog will be kept indoors, as a part of the family, except for periods of exercise in a
     fenced-in area or on a leash.
2. The Adopter agrees to adhere to all local licensing requirements for the dog. The Adopter will be given proof of
     spaying/neutering and rabies vaccination in order to obtain the licensing. The license must be obtained and a copy presented to
     Rescue Me.
3. In the case of adopting a puppy and the puppy has not been spayed/neutered, the Adopter agrees to have said puppy
     spayed/neutered by seven months of age and to provide Rescue Me with such documentation that the procedure has been
     completed by their veterinarian. Further, licensing of the puppy must be obtain according to local licensing requirements
     (usually one year of age). Proof of licensing should be sent to Rescue Me.
4. The Adopter grants Rescue Me the right to make periodic visits to the Adopter’s premises for the purpose of checking on the
     general health and welfare of the dog and to assure that spaying/ neutering/licensing has been adhered to according to the terms
     and condition of this agreement.
5. The Adopter herein states that he/she is 19 years of age or older and that all family members are in agreement with this
     adoption, and to their knowledge, no one in the home is allergic to dogs.
6. The Adopter represents that he/she has never owned an animal which has been confiscated by the Animal Control Officer or
     Humane Society in violation of state or local animal control regulations or animal adoption contracts.
7. If the Adopter is leasing an apartment, he/she agrees to provide written permission, along with a phone number of the landlord,
     allowing the dog to reside in the apartment.
8. If for any reason the Adopter is unable to provide care for the dog, the Adopter agrees to return said dog to Rescue Me. The
     Adopter shall not offer the dog for sale or give the dog to any third party without prior written consent of Rescue Me.
9. The Adopter agrees that Rescue Me shall have the right to immediate possession of the dog if, in the judgment of Rescue Me,
     the dog is receiving inadequate care, being improperly housed or handled, or has not been spayed or neuter on or around the date
     agreed as of the signing of this contract.
10. The Adopter agrees to pay Rescue Me the sum of $300.00 as liquidated damages in the event the terms of this contract are
     breached. This liquidation of damages does not bar Rescue Me from seeking return of the dog by judicial process and/or other
     legal means if necessary. If legal action is instituted, the Adopter agrees to pay reasonable attorney fees and all court expenses
     incurred. The place of venue shall be Oneida County, Utica, New York.
11. The Adopter hereby declares that they have been made aware that a dog’s behavior/personality may change after it leaves Rescue
     Me and accustoms itself to their new home and environment. And, further, Rescue Me makes no representations or warranties
     as to the temperament, health, or mental disposition of any dog put up for adoption.
12. The Adopter fully understands and agrees that there will be NO REFUND OF THE ADOPTION FEE should the adoption
     not be successful. We make every effort to place our dogs in permanent homes whereby they will not be returned, as this can
     cause undo stress on the dog.
13. The Adopter hereby accepts possession of, title to (subject to the conditions of the adoption contract) and responsibility for said
     dog adopted and agrees to release and discharge Rescue Me forever from liability for any injury or damages to any person or
     property caused by the adopted dog, and from any causes of action, claims, suits, including legal fees or demands whatsoever that
     may arise as a result of such injury or damages.
14. THE UNDERSIGNED understands that the parties hereby released and admit no liability of any kind by reason of the said
     adoption and that said adoption fee is made to terminate any further controversy respecting any and all claims for damages that
     said Adopter(s) has heretofore, asserted or might personally or through personal representatives hereafter assert because of said


I have read and received a copy of and, hereby, agree to abide by ALL THE TERMS AND CONDITIONS
set for in this adoption application on the          day of               , 2009.
Signature of Adopter(s):

Signature of Rescue Me Representative:                                    Date:

Adoption Fee: $

Further Terms and Conditions:

Please email to: Sue Sitts

If mailing application, please mail to:   Sue Sitts
                                                   3150 Johnnycake Hill Road
                                                   Hamilton, NY 13346


                                                                                  Rev (10/1/09)


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