Caitlin’s Vine Of Bravery www.caitlinsvineofbravery.org
Dog Adoption Application Form
Contact Information
Full name: ______
Address: ______
Home Phone: ______
Cell/Work Phone: ______
Best time to call: ______
Email address: ______
Date of Birth: ______
Drivers License # ______
( you will need to attach a photo copy or picture of Drivers license ID )
Family & Housing
Occupation: ______
Employer: ______
Employer contact info: ______
Place of employment and position______
What is your work schedule? How many hours are you away from home on an average work week? Is there anyone who stays at home when you aren't?
______
Where will your pet be kept during that time?______
How many hours a day will the dog be left alone? ______
Where will your pet be sleeping during the night? ______
Is anyone enlisted in the military? If yes, how long before you are reassigned or transferred?
______
How many adults are there in your family (their relationship to you)?
______
How many children (ages)?
______
What type of home do you live in? single family, town home, apartment, farm, etc.?
Do you own, rent, live with family?
______
Please describe your household: __ Active __ Noisy __ Quiet __ Average
If you rent, please give the rules governing pets and the landlord’s name and number:
______
(by providing this information you are allowing us to contact your landlord, please inform them of this call so they will speak with us)
How long have you lived at your current address:
______
Are you planning on moving in the near future? ______
What happens to the pet if you move? ______
Do you have a fenced in yard? ______
Whats the size and type of fencing? ______
Do you have a swimming pool? If so, would your pet have access to it? ______
Does anyone in the family have a known allergy to dogs? ______
Is everyone in agreement with the decision to adopt and care for a dog? ______
Do you have time to provide adequate love and attention? ______
When not home would you leave dog in the house or in a crate? ______
Other Pets
Who will be the primary caretaker? ______
Do you understand the costs, challenges and care required for an animal that may live up to 15 years old ? ______
What other pets do you have (specify type and number)?
______
Are these pets up to date on vaccines? ______
Are these pets spayed/neutered? If not..why?______
Are these pets on heartworm preventative? ______
Have you ever surrendered a pet? If so, why ______
Have you ever had a pet euthanized? If so, why ______
Have you ever lost a pet to an accident? ______
How do you discipline your pets and why? ______
Have You ever been denied to adopt by another rescue or control shelter? If so, Why? ______
Veterinarian
Do you have a regular veterinarian? __ Yes __ No
Veterinarian’s name: ______
Clinic Name: ______
Clinic Address: ______
Clinic Phone: ______
(Providing us with this information you are allowing us to call your vet. Please call your vet and ask them to authorize the release of information to us. )
About the Dog You Wish to Adopt
What is the name of the dog you are wanting to adopt? ______
Why do you want this dog? ______
Who will have primary responsibility for this dog's daily care? ______
Are you adopting to keep this dog for its entire life? ______
Will your dog be indoor, outdoor? what outdoor housing do you have?
______
How much will the pet be exercised? ______
Who will have financial responsibility for this dog? ______
Do you agree to provide regular health care by a Licensed Veterinarian? __ Yes __ No
Do you agree to keep the dog as an indoor dog? __Yes __No
When the dog goes out, how do you plan to supervise it? Fenced yard? ______
Do you agree to contact us if you can no longer keep this dog? __Yes __No
( By signing this contract you will be agreeing that if for any reason you cannot keep your dog that you will return him back to us or let us find an approved home instead of placing your dog at a shelter ) By breaking this will result in a $1000 fine!!!!!!
Are you willing to let a representative of Caitlin’s Vine Of Bravery to visit your home by appointment?
__Yes __No
We require a home check, do you agree to a home check? ______
How did you hear about Caitlin’s Vine Of Bravery? ______
Would you be interested in fostering? __Yes __No __Would like to know more
Do you agree to send us updates and pictures of your adopted pet _____
Personal References
Please list someone who is familiar with both you and your pets.
Name:
Address:
Phone:
Relationship (relative, neighbor, friend, etc.):
Name:
Address:
Phone:
Relationship (relative, neighbor, friend, etc.):
All of the information I have given is true and complete. I agree that this pet will remain at the property that is listed above and that I should notify someone if I were to move. This dog will reside in my home as a pet. I will provide it with quality dog food, plenty of fresh water, indoor shelter, affection, annual physical examination and vaccinations under the supervision of a licensed Veterinarian. I agree to keep its shots and rabies up to date. I agree to provide it with a heartworm preventative each month. I agree to never sell, trade, or surrender this pet to anyone without giving prior notice to Caitlin’s Vine Of Bravery. I agree that the rescuer may reclaim the pet if I can no longer keep it. I agree that the adoption fee is non - refundable and there is no reimbursement if the adoption does not work out. I agree that all expenses of my dog after I take possession will be my responsibility and Caitlin’s Vine Of Bravery is released of any liabilities.
Adopter Signature: ______
Please read the following rules and regulations of adopting an animal from Caitlin’s Vine Of Bravery. I agree to abide by this agreement and all county ordinances pertaining the care of my adopted pet. This contract is based on the terms and conditions that follow. If at any time, the adopter faults to comply with this agreement we will have the right to seize the adopted animal immediately. If the adopter decides to relinquish custody at any time during the life of the adopted animal Caitlin’s Vine Of Bravery will be notified immediately and the animal will be returned to the rescue.
Terms of Adoption are as follows:
1. Transfer of Ownership : This animal may not be transferred to any other person/organization for any reason unless approved by Caitlin’s Vine Of Bravery. Adopter agrees that If for any reason they can no longer care for this animal that they will contact Caitlin’s Vine Of Bravery first and either surrender their pet back to us or let us find it or approve a new home.
2. Loss: If adopted animal is lost or stolen, the adopter is required to notify us immediately.
3. Health: Adopter agrees to humanely care for adopted animal, including but not limited to, adequate food, clean water, shelter and annual veterinary care as animal requires and as both state and law mandate. Adopted animals are to be a part of the adopting family for their lifetime, not to live outdoors and under no circumstances will the dogs’ appearance be altered for cometic purposes. Adopter agrees to have adopted animal vaccinated against the rabies virus within the time given or time due and as required by state law and county ordinance to keep the pet up to date on all its shots. Adopter agrees that the dog will be kept on heartworm prevention and receive annual Health check and rabies vaccinations. I understand that by adopting this animal I am taking full responsibility for this animal and I am bound by the mandatory spay/neuter date. I understand that failure to to spay/neuter an adopted animal may result in citation or a warrant.
I understand that I must return a copy of this contract signed by my veterinarian by the given date with a copy of proof of spay/neuter. If I do not provide proof that my adopted animal has been spayed or neutered I will be cited and have to appear in court for this ordinance violation.
4. Care: Dogs are not allowed to be tethered or chained as a means of confinement. Dogs are to be exercised in a fenced area or on a leash daily. Dogs are not allowed to live outside only, fenced yard or otherwise. Dogs are not free to roam at any time. Dogs are not to be left in a crate for longer than 8 hours a day. I agree that my adopted animal with not be left on a chain, cable or runner unattended for any length of time, due to the risk of the animal’s well being. I agree that I will provide shelter for my adopted animal at all times. I understand that adequate shelter must protect my animal from all types of weather. I agree to supply my adopted animal with adequate food, water and veterinary care at all times.
5. Updates : Adopter agrees to provide updates via texting or social media
6. Home visits: Caitlin’s Vine Of Bravery reserves the right to perform scheduled or non- scheduled post adoption home visits to ensure the animal is happy, fitting into the adoptive home and living under the terms of the adoption contact, if animal is found living outside or in poor condition the animal will be seized immediately.
7. Proper introduction: I agree and understand that if I have any other pets in my household to adhere to and follow the strict explanation of the “ proper interaction” procedure and acclimation of new pets to prevent any tragedy that may result if not followed, to insure the safety of your household pets and or person or persons in your household and our dog you are adopting while in your care, as we are not responsible for any damages or harm to your pets, yourself, and or person or persons in your household. We cannot stress enough the importance of following our “ Proper Introduction “ procedure, for the safety of your family, friends pets and ours.
8. Transport: I agree if I am transporting this pet anywhere away from home, I will have a proper leash/ hardness and collar on the pet with a rabies tag or copy of current rabies certificate and identification. I also agree to never under any circumstances transport this pet outside of the interior vehicle, such as a bed of a pick up truck, or trailer because of how dangerous it is.
9: Reservation of Rights: Caitlin’s Vine Of Bravery reveres the right to follow up on adopted animal during its lifetime. It is understood if the adopter misrepresents, falsifies information to obtain an animal, and doesn't follow all of these adoption requirements that Caitlin’s Vine Of Bravery reserves the right to terminate this adoption contract, and immediately confiscate the adopted animal without warning.
A copy of your local ordinance is available upon request. I understand that I must abide to all county ordinances, not only those listed above. I understand that by signing this
document I am acknowledging that I have read and understand all of the above requirements and information and that I/We comply with all the terms.
Adopter Signature: ______Date: ______
Caitlin’s Vine Of Bravery Employee: ______
Fix By Date : ______
Both the adopting parents and Caitlin’s Vine Of Bravery have agreed upon the total of $____ for help with expenses incurred by saving this dog.
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