Adoption Fee is $225.00. Adoption fee is
non-refundable after 7 days.

Please e-mail adoption application and adoption agreement to: E-mail to:

OR

Mail to: Arkansas Southern Dog Rescue
12 Melody Lane
Ward, AR 72176

  • Today's Date:
  • Your First Name:
  • Your Last Name:
  • Your Date of Birth:
  • Street address:
  • City:
  • State:
  • Zip Code:
  • County:
  • Email address:
  • Phone home:
  • Phone work:
  • Phone cell:
  • Your Occupation:
  • YourEmployer's name:
  • Your Employer's street address:
  • Your Employer's City, State & Zip Code:
  • Animal's name:
  • Description of animal (as specific as possible):
  • Who do youlive with (spouse, roomate, alone etc)?
  • Do you own or rent?
  • Accommodation (house, townhouse, apartment, mobile home):
  • Does your landlord allow pets?
  • Can you provide a copy of your lease if requested?
  • May we contact your landlord?
  • Landlord's name:
  • Landlord's phone:
  • How long have you rented at your current address?
  • If less than 5 years, please provide your full previous address:
  • Do you have a fenced yard?
  • Do you have a kennel?
  • Please describe yourfenced yard or kennel, providing approx dimensions:
  • How will you handle your pet's exercise needs?
  • Do you own and use a crate?
  • Number of adults in household:
  • Number of children in household:
  • What are your children(s) ages?
  • How many hours each day will your pet be alone?
  • Who will be responsible for your pet's care?
  • Does your family want a new pet?
  • Does any family member NOT want a new pet and if so, why?
  • Please describe your lifestyle:
  • Please list species and age all of other pets owned:
  • Are all of your pets current on their vaccinations and heartworm prevention?
  • Are all of your pets spayed\neutered?
  • How many animals have you owned during the past 5 yrs?
  • Where are these animals now?
  • Your veterinarian's name:
  • Your veterinarians's street address:
  • Your veterinarian's city & state:
  • Your veterinarian's telephone number:
  • How will you handle behavior issues?
  • How do (or will) you reprimand your pet?
  • How will you handle your new pet's adjustment?
  • How did you hear about ASDR?
  • Have you ever adopted a pet from an animal rescue before?
  • Do you understand that rescued animals are often nervous/scared when moving to a new environment? (It may take them a few hours to a few weeks to adjust to their new home environment and to trust you.)
  • Do you have the time and/or patience to housetrain a dog, if it isn’t already trained or is scared coming to a new home and has some accidents? How will you respond to accidents?
  • Please check any/all circumstances that would cause you to give the animal back to us:

A new job (working more, longer hours)

Kids getting busy, no time for pet

Divorce

Moving to a new home

New Baby

If the pet needed expensive vet care

Bad habits

No circumstances will cause me to give this pet back

  • Why do you wish to adopt this dog or cat? (please check all that apply)

Companion animal

Watchdog

Gift to someone inside the household
Gift to someone outside the household
Hunting Dog

Other

  • Do you plan to move in the foreseeable future?
  • If you were to move, what would happen to this pet? (please check one)

I would give puppy back to ASDR

We would try to find the puppy a home

We would take the puppy with us no matter what

Depends on circumstances

  • Where will your pet sleep at night?
  • Where will your pet spend most of his time?
  • Dogs can live to be up to 18 years. Are you willing to make this commitment?
  • Do you have the funds to provide routine and emergency care?
  • Do you agree to spay\neuter this animal if not already spayed\neutered?
  • Do you agree to fax proof of spay\neuter to ASDR within 14 days after it is performed?
  • Do you agree to provide all necessary health care and preventive annual shots for this animal?
  • Do you certify that all information provided on this form is true and correct?

Pleaseadd any additional comments or information that you feel would help us in consideration of your application:

Please carefully read this agreement and add your initials to the last page to show you have read, and do agree to all the terms.

Arkansas Southern Dog Rescue

Adoption Agreement

This ADOPTION AGREEMENT is entered into this date by and between Arkansas Southern Dog Rescue or ASDR, hereinafter ASDR, an Arkansas non-profit corporation and, hereinafter the ADOPTER, for the adoption of the above identified pet.

TERMS AND CONDITIONS

Adopter understands that there is a risk involved in rescuing a dog and that in rare cases, this pet can have an illness such as distemper or parvo, that may or may not be treatable, may require extensive treatment, and that may or may not result in a fatality. In this case adopter agrees to assume all expenses and hold ASDR harmless.

The adopter agrees to provide the pet with a good and safe home with proper care and attention. The pet will not be allowed to ride loose in the back of a pickup truck. The pet will not be chained. When the pet is outdoors, it shall be provided protection from the elements by a dry, insulated, draft-free shelter and shall be provided shade from the sun at all times. It is further agreed that the pet shall be provided with adequate food and shall have access to fresh water at all times when outdoors.

In the event that ASDR discovers the inhumane treatment of this pet or breach of this agreement, it is agreed ASDR has the right to immediately take possession of the pet upon written notice to the adopter at the residence of the pet. It is understood and accepted by the adopter that home visits may be conducted by a person representing ASDR to check on the welfare of the above-named pet.

The adopter agrees that this pet will be examined by a veterinarian at least once each year and will receive adequate vaccinations and treatments to ensure good health, including heartworm prevention.

If the pet was not tested for heartworms, generally because the local veterinarian has determined that the chance of heartworm infection is very low due to a young age, adopter agrees to have the pet tested at the next annual examination at the latest, and then at intervals recommended by your veterinarian.

The pet has already been spayed or neutered, vaccinated and tested\treated for internal parasites and infections as determined by a local veterinarian. Please refer to 6. below.

In rare cases – this box will be checked if the pet has not already been spayed or neutered because it is too young or too sick. Adopter agrees to have the animal spayed or neutered by the time the pet attains the age of four (4) months unless, in the opinion of a licensed veterinarian, the pet is medically compromised to the extent it cannot withstand immediate sterilization (such opinion to be noted in the pet's veterinary records and made available to ASDR upon request), in which event the pet shall be sterilized as soon as medically possible. PROOF OF STERILIZATION MUST BE PROVIDED TO ASDR AT 4406 Trapp Rd., NorthLittle Rock, AR72118 WITHIN 7 DAYS AFTER THE PET OBTAINS THE AGE OF FOUR (4) MONTHS EXCEPT AS NOTED. THE ONLY EXCEPTION TO STERILIZATION IS WHEN TWO VETERINARIANS LICENSED TO PRACTICE CERTIFY THAT IT IS UNLIKELY THAT THE ANIMAL WILL EVER RECOVER TO THE EXTENT THAT IT CAN BE SAFELY STERILIZED. ADOPTER REPRESENTS AND WARRANTS TO ASDR THAT ANY ANIMAL WHICH CANNOT BE STERILIZED WILL NOT BE USED FOR BREEDING PURPOSES.

This pet is already sterilized. This pet will be vaccinated and tested\treated for internal parasites and infections as determined by a local veterinarian.

  1. ASDR makes no warranties or statements regarding the pet's health, medical status or temperament. Adopter understands that the pet has been rescued from an animal shelter and may have been exposed to communicable disease(s) which MAY REQUIRE A FOLLOW UP TREATMENT and that the pet should be re-examined within a reasonable period after arrival for internal parasites and should be re-treated if necessary. It is further agreed that environmental changes may affect and change the temperament of the above-named pet and that ASDR has no liability or responsibility of any nature regarding later issues with the pet, or injuries or damage to any person or property which may be caused by the pet. The adopter agrees to indemnify and hold harmless ASDR and its members or representatives against any and all claims for any injury or property damage to the adopter or anyone else.
  1. In the event that the adopter decides they can no longer keep the pet, adopter agrees to contact ASDR for immediate return of this pet to the rescue. Adopter agrees not to surrender the pet to any animal shelter or animal control facility.
  1. It is agreed and understood by the adopter and ASDR that this agreement sets forth all promises, agreements, conditions, and understandings between them, oral or written and that both parties have fully read and understand all provisions of the agreement.
  1. This agreement shall inure to the benefit of and be binding upon the adopter and ASDR and their successors or beneficiaries.
  1. In the event of the employment of an attorney by ASDR on account of any violation of this agreement, it is agreed the adopter shall pay ASDR’s reasonable attorneys' fees and court costs.

IN WITNESS WHEREOF, the parties have executed this agreement on the dates set forth below. My signature indicates that I have read and understand the “Disclaimer” below. If this is executed via the web, please type in ALL information and return this as a file attachment PRIOR to the veterinarian appointment for your new pet.

ADOPTER(s):

Signature: ______

Printed Name: ______

Date: ______

Signature: ______

Printed Name: ______

Date: ______

ASDR REPRESENTATIVE:

Signature: ______

Printed Name: ______

Title: ______

Date: ______

DISCLAIMER

Arkansas Southern Dog Rescue is an organization whose purpose is to find homes for animals that have been lost, abandoned, abused, retained by a shelter under threat of euthanization, or any other dangerous situation in which a homeless animal may be found.

Arkansas Southern Dog Rescue will see that the animals which are in its custody are treated kindly and are well cared for.

However, persons adopting any animal should take immediate action to see that the animal is immunized and otherwise checked for their current health status, if this was not provided already by ASDR.

The adopting person understands that it is very important that animals already in their home be in good health and be current on immunizations to reduce the risk of contracting an illness or disease from the adopted animal. The adopting person is advised to consult with their veterinarian regarding any recommended quarantine period prior to letting the adopted animal have any contact with other animals already in the home.

The adopting person understands that most animals that Arkansas Southern Dog Rescue are attempting to place are from an unknown situation, and have spent time in an animal control facility, and therefore may be fearful, nervous or have other characteristics that may be considered undesirable and the adopting person is prepared to work patiently with the adopted animal to overcome any such problems.

Arkansas Southern Dog Rescue will try to identify any animal that seems to demonstrate aggressive behavior. However, all pets can act in ways that are unexpected.

Arkansas Southern Dog Rescue advises the adopting person to treat newly adopted animals with care and attention to see what type of characteristics they demonstrate.

The adopting person understands that the temperament and disposition of any animal they adopt is completely unknown and not guaranteed at all. The adopting person assumes all responsibility for evaluating the animal and its suitability for their family.

Arkansas Southern Dog Rescue makes no representations regarding the health or demeanor of any of the animals which it places for adoption and advises the adopting person to take all necessary care as their pet is adjusting to its new surroundings. Adopter agrees to administer as directed any medications prescribed and provided by ASDR upon arrival of the animal. ASDR recommends a follow up vet visit be scheduled for a general physical exam and fecal to detect and treat any residual parasites that may remain after initial treatment.

The adopting person also agrees to indemnify and hold harmless Arkansas Southern Dog Rescue for any act or conduct of the animal after delivery of the animal to the adopting person, and also any additional expenses relating to unforeseen illness after the animal arrives.

Please initial or type your initials here to indicate that you have read, understand and agree with this disclaimer:

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