Application – 2nd Chances Rescue

Application

Name *

First

Last

Address *

City, State and Zip code *

Email *

Phone Number *

1. Name of dog you are interested in

2. Why would you like to adopt this dog? (Companion, watchdog, family pet, gift, other...) *

3. Do you live in a house, apartment, condo, townhouse, mobile home or other? *

4. Do you rent or own? *

4a. If you rent, does the lease agreement allow for pets? Are there any breed or size restrictions? Any homeowners association restrictions? Please explain.

4b. If renting, please provide the contact information for the leasing office or manager:

5. Do you have a fenced yard? *

5a. If yard is fenced, please describe type and height:

6. Do you have a pool? *

7. Do you have a gardener? *

8. List the number of people and their ages who are living in your household: *

9. Is anyone in your household allergic to animals? If yes, please explain. *

10. Are all members of your household aware you are planning on adopting a dog? *

11. Describe where your pet will stay throughout the day: *

12. On average, how many hours a day will your pet be home alone? *

13. Where will your pet sleep at night? *

14. How much money do you plan to spend on this pet throughout the year, including medical? *

15. What plans do you have for this pet when you travel? *

16. Please describe any pets you currently have in the household. Include age, size, breed etc. If you do not have any, type "none". *

16a. If you currently have dogs, are they spayed or neutered? *

Yes
No
I don't know/don't have a dog(s)

16b. If you currently have dogs, are they up to date on vaccines? *

Yes
No
I don't know/don't have a dog(s)

16c. If you answered no to either of the above two questions, please explain why:

17. Have you owned dogs in the past? *

17a. If you answered yes to the above question, what happened to them?

18. Current Veterinarian name and phone number (if applicable)

19. If your present living conditions change (i.e. move, change jobs, divorce), what will you do with this pet? *

20. Would you give this pet up if the pet barks or whines? *

21. Would you give this pet up if the pet has a potty "accident" in the home? *

22. Would you give this pet up if you lose your job/source of income? *

23. Would you give this pet up if you have to move? *

24. Would you give this pet up if there is a marriage, divorce, or new baby? *

25. Would you give this pet up if the pet becomes aggressive? *

26. Would you give this pet up if the pet becomes ill or old? *

27. Would you give this pet damages property or furniture? *

28. Are there any reasons that may cause you to give up your pet? Please explain.

29. Are you willing to commit to training class or program if this pet requires it? *

30. Do you understand that it is unknown if a pet is housebroken when placed in a new environment? *

31. Are you willing to potty train this pet if needed? *

33. Are you planning on training this pet? *

34. How do you plan on disciplining this pet? *

35. How long are you willing to give this pet to settle and bond with you and other pets in their new home? *

36. At the time of your adoption, we feel the dog that you are getting from us is healthy. We can't possibly know what may happen in the future, but if your dog becomes ill, what will your action be? *

37. I understand I am committing to care for this animal and have it as part of my family for its natural life, which can be up to 17 years for some pets. *

38. I am financially able to provide for the animal's needs. This includes food, supplies, shelter, veterinary care, heartworm, flea, tick and parasite prevention. These can cost up to approximately $800 per year. *

39.I have adequate time to spend with my new pet, including time for exercise, training and grooming. *

40. I understand that if I move, my will make the move with me. *

41. I understand that I must comply with all state and local ordinances concerning pet licensing and vaccinations. *

42. I understand that there may be additional requirements set forth that will be disclosed based on which pet is chosen and the nature of the pet's personality, needs, dislikes etc. *

43. I understand the microchip shall always be updated and that 2nd Chances Rescue is names as secondary contact in case of crisis, death, disaster, incarceration, etc. *

44. I understand that this pet shall never be given away, sold, transferred, abandoned, or neglected at any time and for any reason. *

45. I understand that 2nd Chances Rescue has the right to reclaim this pet if the contract is broken or violated. *

46. I agree to routine follow-up post adoption. *

47. I understand that there are no refunds of adoption fees for any reason. *

48. I understand that the dog I am adopting may not be altered or fully vaccinated yet. *

49. I understand that I need to give 2nd Chances Rescue two weeks to get Adoption Certificate, shot records, spay neuter and microchip information. *

50. I am aware of the adoption fee for the dog that I am adopting. *

I understand that I am responsible to ensure the dog I am adopting contues to receive all vaccines, spay/neuter and microchip. Failure to comply can result in 2nd Chances Rescue revoking our adoption. All of the above information is true and complete. I agree to follow the rules and policies that 2nd Chances Rescue has set forth here. I understant that it is my decision whether to adopt any particular pet or not. I will not hold 2nd Chances Rescue liable for any damage, harm, or injury caused directly or indirectly to any person or property by any pet I may adopt. Adoption fees are non-refundable. We will allow you to choose another dog in exchange. 2nd Chances Rescue at its sole discretion, reserves the right to refuse an applicant for any reason or no reason. I have read the disclaimer and agree to these terms and conditions. Electronic Signature:

Date