Electronically is faster, and will guarantee faster processing of your application!
*************Please note: Completed Application DOES NOT Guarantee Adoption************
Dog's Name: Date of Application:
1. Name :
Address:
City State: Zip
Telephone
Home: cell: work:
2. Number of people in home:
Adults: ages:
children: ages:
3. Why do you want to bring a new dog into your home?
Is everyone in the household in agreement on adopting a new dog?
When will you be ready for your new dog?
4. Do you rent or own ?
Type of housing: House Apartment Condo Townhouse
5. If rental, landlord's name:
Phone:
Are animals permitted?
5. How long have you resided at your present address?
Are you planning to change residence in the near future?
If yes, please explain:
6. Do you have a yard?
Dimensions of yard:
Fenced in? Height of fence?
Not fenced in: Partially fenced?
7. Where will your dog be exercised?
8. How much daily exercise will you provide (explain)?
9. How long will your dog be left alone during the day?
10. Where will your new dog be kept while alone?
11. Do you own a crate?
Have you ever crate-trained a dog? _____ Will you be crating your new dog? _____
12. Do you understand that your new dog may develop some issues as it adjusts to it's new home?
Will you tolerate the following issues during that adjustment period?:
housebreaking accidents? Chewing?: Barking/whining?:
If no, please explain:
If these issues do not get resolved in a reasonable amount of time, what will you do?
What do you consider a reasonable amount of time?
13. Have you ever taken a dog to obedience training?
Will you attend a training classes with your new dog?
If no,please explain:
14. How long have you been searching for a new dog?
Where have you searched?
Why did you choose this particular dog?
15. Does anyone in your household have any known allergies to dogs?
16. Is anyone in the household fearful of dogs?
Has anyone in the household ever been bitten by a dog?
If yes, please explain:
17. Do you have animals now?
What kind? (list breed/age/sex)?
Are they neutered or spayed?
If no, please explain:
How will they react to a new dog in the home:
18. List any animals you have had in the past, include name, breed & sex:
How long did you own the pet/s?
Reason for no longer owning the pet?
19. Has any pet of yours ever been lost?
hit by a motor vehicle?
If yes, please explain:
20. Veterinarian Information:
Name :
Phone:
Address:
City/State:
21. A dog can live 12-18 years. Are you financially prepared and willing to give this animal the medical care it requires for its lifetime?
22. Please list 3 references (2 non-family members):
a) Name: Relationship: Phone:
b) Name: Relationship: Phone:
c) Name: Relationship: Phone:
22. In adopting this dog you agree to:
a. Permit SHRR Rescue volunteers to conduct a home visit upon placing the dog and follow up calls for the purpose of assuring the proper care and adjustment of the dog.
b. NEVER put the dog in a pound or shelter. In the event you cannot keep the animal, you MUST IMMEDIATELY contact Superiors Haven Rottweiler Rescue at (610) 433-9307or e-mail at superiorshaven@yahoo.com
c. Purchase an identification tag for your new dog within the first 24 hours of possession. Notify us IMMEDIATELY if the animal becomes missing or lost so we may assist in finding it.
d. Accept possession, title and responsibility of the animal described above at your own risk, and hereby release and waive any right against SHRR which you may have now, or in the future, for any damages to person or property caused by said animal. Recognize that animals, like humans, differ in their responses to different situations and that we cannot make any claims or representations as to previous or future behavior and actions of the animal.
e. Have the animal checked by your veterinarian within 7 days. Provide medical care at your own expense of any conditions previously unknown to Superiors Haven Rottweiler Rescue as well as routine yearly exams for as long as you own the dog.
IN SIGNING BELOW YOU AGREE TO ALL OF THE TERMS ABOVE AND UNDERSTAND THAT IF YOU HAVE GIVEN FALSE OR MISLEADING INFORMATION OR DO NOT FOLLOW THE TERMS OF THIS CONTRACT, ANY OF THE ABOVE AS INDIVIDUALS OR AS AN ORGANIZATION MAY RECLAIM THIS ANIMAL AND START LEGAL PROCEEDINGS AGAINST YOU, AT YOUR EXPENSE, AND MAY ASSESS DAMAGES IN THE AMOUNT OF $1000.00 AGAINST YOU. FAILURE TO COMPLY WITH ANY OF THE ABOVE TERMS OF THIS AGREEMENT MEANS THAT THE ANIMAL WILL REVERT TO ANY OF THE ABOVE-MENTIONED OR THEIR REPRESENTATIVES. SUPERIORS HAVEN RESERVES THE RIGHT TO RECLAIM THE ADOPTED ANIMAL IF THE ANIMAL IS NOT BEING TREATED HUMANELY OR IS ABUSED. THIS WOULD INCLUDE BUT IS NOT LIMITED TO INADEQUATE FOOD, WATER, SHELTER, SOCIALIZATION, AND EXERCISE.
I HAVE READ, UNDERSTAND, AND WILL COMPLY WITH ABOVE STATED CONDITIONS.
Signature: Print Name: Date:
Approved by: ________________________ Adoption fee: _________ check: ______ cash:
