Mine & Explosive Detection Angel Paws Retirement Rescue Adoption Request

Mine & Explosive Detection Angel Paws Retirement Rescue Adoption Request

CONTRACT WORKING DOG (CWD) ADOPTION/FOSTER APPLICATION

Thank you for considering the adoption of a CWD. Please take a few moments to carefully read and complete this application. The decision to adopt a CWD is one that must be taken seriously. In order to ensure that you and the CWD will be happy and safe for years to come, we need to take time to discuss your expectations and the animal’s individual needs and personality traits. Please answer all the questions as thoroughly as possible.

PERSONAL DATA

Name (Last Name, First, MI) / Spouse (Last Name, First, MI)
Home Address / Apt
City / State / Zip Code / Home Phone
( )
Are You
( ) Working ( ) Retired ( ) Attending school ( ) Homemaker ( ) Other
Employer’s Name / Work/Cell Phone
( ) / Spouse Employer’s Name / Work/Cell Phone
( )
Address / Working Hours / Address / Working Hours
Email Address

HOUSEHOLD INFORMATION

Are there any other adults living in the household?

( ) Yes ( ) No If yes, list below the other household members :

Name / Employer’s Name / Address / Work Phone / Working Hours
1. / ( )
2. / ( )
Max. number of hours CWD will be left alone daily? / Who will be caretaker for the pet?
( ) Self ( ) Spouse ( ) Children ( ) Roommate
How many children are at home? / List ages here:
Do you:
( ) Own ( ) Rent / Does your landlord/lease allow pets?
( ) Yes ( ) No / Do you have screens on your windows?
( ) Yes ( ) No
Where will your pet be kept primarily?
( ) Inside ( ) Outside /

Do you have a fenced-in yard?

( ) Yes ( ) No How high is the fence?
Are any members of your household allergic to pets?
( ) Yes ( ) No

PET INFORMATION

List below any pets you have owned in the past 5 years: CIRCLE YOUR RESPONSE
Type of pet / Age / Spayed/Neutered / Years Owned? / Do you still have this pet? If not, where is it?
1. / Yes No / Yes No
2. / Yes No / Yes No
3. / Yes No / Yes No
4. / Yes No / Yes No
Have your pets been vaccinated yearly?
Yes No / Do you give monthly Heartworm Preventative?
Yes No Which one? / Flea/Tick Monthly?
Yes No
Address / Phone
( )

PHONE REFERENCES

(People not living with you who can be reached by telephone who know your history and treatment of animals. You may also submit letters of reference in addition.)

Reference Name: / Address: / City, State, Zip / Phone
( )
( )

I certify that the above information is true to the best of my knowledge.

______

Signature of Adopter Date

SUPPLEMENTAL ADOPTION INTERVIEW FORM

The following questions will be answered to the best of the candidate’s K9 knowledge. These answers will help us make the best possible adoption decision regarding placement based on the candidate’s level of experience.

Applicant’s Name:
Animal’s Name: Breed: Age: Sex:
Why are you interested in giving a home to this dog?
Have you previously owned a dominant dog?
( ) Yes ( ) No
What breed types have you owned in the past?
How long did you have the dog(s)? Where are they now?
Do you intend to use this dog for personal protection or commercial property security? If yes, explain.
( ) Yes ( ) No
Did the dog(s) ever bite or show aggressive behavior towards you/family members/or any other individuals? If yes, explain what happened:
( ) Yes ( ) No
Have you ever trained a dog before?
( ) Yes ( ) No If yes, what type of training methods did you use? What type of discipline/corrections would you use with a dog?
If the dog refused to obey a command such as “get off the couch”, explain in detail what you would do to correct this behavior.
If you returned home to find that your dog had chewed your favorite shoes or urinated on the floor what would you do? Explain what you would do to correct this behavior.
If the dog needs professional training, are you willing and financially able to enroll the dog in a group class or with a private trainer? ( ) Yes ( ) No
Have you applied to adopt a MWD or CWD before?
( ) Yes ( ) No If yes, when? From where did you get the dog?
How did you hear about our adoption website?
( ) Newspaper ( ) Internet ( ) Friend ( ) TV, What show? ( ) Other ______
Someone in my home is nervous or unsure of dogs…
( ) Very (ex. bitten as a child) ( ) Moderately ( ) Some (no experience with dogs) ( ) N/A
I have:
( ) Indoor cat(s) ( ) In/out cat(s) ( ) Dog(s) ( ) Other pets, please list
The noise/activity level in my home is usually:
( ) Low ( ) Medium ( ) High
When it comes to keeping a clean and tidy house I am:
( ) Very Particular ( ) Particular ( ) Easy going
When it comes to pets lying/sleeping on the bed or furniture I: These are indoor dogs.
( ) Would allow ( ) Would not allow ( ) Don’t care
I need a dog that will tolerate being alone ______hours.
I enjoy brushing or grooming my dog:
( ) Rarely ( ) Occasionally ( ) Daily ( ) Weekly ( ) Monthly
I would enjoy taking my dog in the car:
( ) Daily ( ) Weekly ( ) Frequently ( ) Once in a while
I prefer a dog whose energy level is:
( ) High ( ) Medium ( ) Low
I prefer a dog that:
( ) Will enjoy walking with me on leash
( ) Will enjoy walking with me on or off leash
( ) Will run, jog or hike with me
( ) Will exercise him/herself in our yard
( ) Requires little exercise
( ) Enjoys playing ball.
I have or I am planning for:
( ) A fenced yard ( ) A dog run ( ) A stationary tie-out
My ideal dog would:
______
______
______
______

CANDIDATE AGREEMENT SECTION

Initials

I accept full liability for all actions of my CWD. /
I agree to keep this dog in my home and make it part of the family.
I agree to provide a fenced yard to safely contain CWD. (Minimum: 5 foot fence -- 200 sq ft exercise area) Please address any questions you have on this and we can discuss further.
I agree to obtain and provide reasonable medical care. (Vaccinations, Yearly Exam, External and Internal Parasite Control, Dental Cleaning)
I agree to notify any veterinary staff that this dog is a former Contract Working Dog.
I agree to provide adequate food and water and the necessary supplements.
I have been fully briefed on training received by this Contract Working Dog.
I agree to notify groomers or others tending to my dog that he/she is a former Contract Working Dog.
I understand that I need to abide by local animal control, dangerous animals, and licensing laws.
I have been briefed on list of critical commands used to control this Contract Working Dog’s behavior
I have received a written summary of this Contract Working Dog’s shot records.
I understand that my adopted Contract Working Dog must be neutered/spayed within one month of adoption.

As a candidate for one of these CWD’s a Home Visit will be required.

______

Owner Candidate Signature Date

Please tell us anything else you would like us to know about you and why you are interested in adopting a contract working dog:

SPAY/NEUTER AGREEMENT (ADDENDUM A)

PERMANENT OWNERSHIP of this CWD is contingent upon your compliance with this Addendum.

Proof of the spay/neuter, if K-9 is not, must be received by Mine & Explosive Detection Angel Paws Retirement Rescue Adoptionswithin THIRTY (30) days after the surgery. ______

In the event that the dog’s health does not allow thisagreement to be honored, MINE & EXPLOSIVE DETECTION ANGEL PAWS RETIREMENT RESCUE Adoptions must be provided with a statement from your veterinarian that the CWD is not in condition for surgery. Based upon the veterinarian’s evaluation of this dog the adopter will establish the earliest date that the procedure can be performed. ______

IT IS THE RESPONISIBILITY of the ADOPTER not the veterinarian, to ensure MINE & EXPLOSIVE DETECTION ANGEL PAWS RETIREMENT RESCUE Adoptions has received verification the surgery has beenperformed. ______

Failure to comply with this agreement by the date below, unless otherwise agreed to in writing, will be considered a breach of the CWD ADOPTION Contract, and the Adopter will contact MINE & EXPLOSIVE DETECTION ANGEL PAWS RETIREMENT RESCUE Adoptions for transport of the CWD back to MINE & EXPLOSIVE DETECTION ANGEL PAWS RETIREMENT RESCUE. ______

There is a transition time expected for the CWD to adjust when in a new environment, if the Adopter feels it isn’t working, the Adopter will return the CWD to Mine & Explosive Detection Angel Paws Retirement Rescue.______

By my signature below, I agree to have this dog spayed/neutered, if the CWD isn’t, by no later than ______.

Adopter Signature:______Date:______

Adopter Name: (please print):______

Address:______

City:______State:____ Zip:______

Tel. (H):(______)______(C):(______)______

SPAYING OR NEUTERING YOUR DOG IS HEALTHIER FOR THEM

Neutering a male eliminates the possibility of testicular tumors, prostate issues and efficiently reduces the chance of prostate problems. Neutering decreases the chance of perianal tumors and hernias, which are in older, unneutered males. Neutered males are less likely to escape a yard and find a female in heat. This reduces the chance of them being hit by cars, getting into fights or lost. Females spayed before their first estrous cycle reduces her chance of mammary tumors, ovarian cancer and uterine infection.

EMAIL or SCAN Spay/Neuter Veterinary Verification to

RELINQUISH/REHOME/HOUSING AGREEMENT (ADDENDUM B)

Relinquishment

I, ______agree to notify MINE & EXPLOSIVE DETECTION ANGEL PAWS RETIREMENT RESCUE ADOPTIONS at the numbers and email provided below, in the event I ever need to relinquish CWD______. I will give back the CWD to MINE & EXPLOSIVE DETECTION ANGEL PAWS RETIREMENT RESCUE ADOPTIONS or representative of adequate time to rehome or come get my CWD for the purposes of rehoming the dog.

Rehoming

If, for any reason, there is a need to rehome my adopted CWD ______, I understand the CWD will be returned to MINE & EXPLOSIVE DETECTION ANGEL PAWS RETIREMENT RESCUE.

Housing

I understand that my adopted CWD______MUST be sheltered in a Home, climate-controlled environment. The dog will NOT be left outside UNATTENDED FOR ANY REASON and will be treated as a family member. I also understand and acknowledge that there may be a time of transitioning and adjustment with regard to housebreaking and am willing to persevere until the learning curve has been achieved.

Adopter Signature:______Date:______, 2011

Adopter Name: (please print):______

Address:______

City:______State:______Zip:______

Tel. (H):(_____)______(C):(______)______

1. Release of Liability and Hold Harmless Clause:

In consideration of the receipt of the above-referred dog, the Adopter hereby understands, promises and agrees to forever release, discharge, indemnify and covenant to hold harmless Mine & Explosive Detection Angel Paws Rescue, its directors, officers, volunteers and successors and assigns from any and all claims, damages, costs expenses, loss of service, actions and causes of action arising out of any act or occurrence relating to the above referenced dog from the present time forward.

2. Adoption Donations is Voluntary and not required for adoption, but will help to defray costs associated with not only bringing these CWD’s back but their care until adoption.

In conjunction with the adoption of this dog, I have tendered a $ adoption donation, paid in the form of: ______to

Mine & Explosive Detection Angel Paws Rescue receipt of which is hereby acknowledged. This donation represents a contribution to defer Mine & Explosive Detection Angel Paws Rescue expenses both directly and indirectly attributable to the rescue of this and other dogs. Adoption donations are NON-REFUNDABLE, and tendered as a donation to Mine & Explosive Detection Angel Paws Rescue. There are no exceptions to this matter unless a director provides consent in written form BEFORE the time of adoption.

3. Health and Temperament

Mine & Explosive Detection Angel Paws Rescue makes no explicit or implicit guarantees in reference to the health and/or temperament of the dog. The Adopter assumes all responsibility for treatments of any and all conditions of physical or temperament changes that may occur. While Mine & Explosive Detection Angel Paws Rescue makes every effort to place only healthy animals, with good temperaments, it cannot guarantee the health of any animal and may not be held responsible for any medical expenses that may be incurred after the date of adoption. The parties hereby acknowledge that Mine & Explosive Detection Angel Paws Rescue has not made any warranties relating to the dog, either express or implied, without limitation, any warranties regarding health, temperament or whether the dog is housebroken.

4. Veterinarian Release of Information

Adopter understands and agrees that Mine & Explosive Detection Angel Paws Rescue. shall have the right to contact ANY veterinarian who has examined and/or treated the dog for the purpose of gaining information regarding any aspect of the dog’s health and care including but not limited to verifying the purchase by Adopter of heartworm preventative and/or ascertaining whether or not the dog has received heartworm tests, fecal examinations, vaccinations and/or other treatments as required by this contract. Adopter explicitly authorizes without further notice, the release of any information regarding the treatment, training or other interaction of the dog by or with any animal control officer, law enforcement officer, veterinarian, trainer, groomer, boarder or any other service provider.