Dog Adoption Application

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Please fill out this form honestly, and email RrrrescueMaria@gmail.com with any questions.
All questions must be answered. If they do not apply to you, please write N/A.

Email *

Please add Rrrrescuemaria@gmail.com to your contacts so that our response does not go to spam. *

Required

First Name *

Last Name *

Age *

Driver's License State, # and Expiration Date *

Address *

Street Address

City *

State *

Zip Code *

Phone Number *

Which dog would you like to adopt? *

We sometimes require home visits. May we visit your home? *

Yes

Do you rent or own? *

If you live with family, do they rent or own?

Rent

Own

Do you have your landlord/homeowner's permission to bring a new pet home? *

Please list landlord's name and contact information. *

Who will be the primary caregiver for the dog? *

What do you know about heartworm disease? (It's ok to research, we'll wait.) *

Which heartworm prevention do you use? *

Does anyone in your home have allergies or asthma? *

Occupation and Employer? *

What would cause you to give up a dog? *

Excessive Barking

Allergies

Pressure from significant other or family member

dog related expenses

chewing

housetraining problems

Other:

Required

Who is your current Veterinarian? *

Do you have children? What are their ages? *

Do small children often visit your home? *

Yes

Are you able to afford yearly vet visits for vaccinations and checkups? *

Yes

Are you aware that dogs can live up to 15+ years? Can you care for a dog for that long? *

Would you be willing to adopt a dog with special needs? *

(amputated limb, blind, deaf, old age, needs daily meds, etc)

If something were to happen to you, who would take care of this dog? Please list a name and number. *

Are you able to afford emergency medical attention if needed? *

Where will this dog live? *

Inside

In the garage/laundry room

Inside/Outside

Outside

Other:

List any other pets in your home, their Name, species, breed, and age. *

When was your last visit to the vet and why? *

How will you deal with behavior problems? *

If you have other pets, how will you introduce your new dog to your household? *

Where did you find this dog? *

Petfinder.com

Facebook

Word of Mouth

Petsmart Adoption Day

Special Event

Other:

Contract *

I agree that the Adopted Pet is being adopted for myself and will not be sold, adopted or given to another party.

I agree that the Adopted Pet will not be allowed outdoors without proper supervision, unless the Adopted Pet is in a secure fenced in area. When taking my Adopted Pet outdoors not within a secure fenced in area, Adopted Pet will be on a secure leash and wear proper ID

I agree that this dog is to be a companion animal, not a guard dog. The dog will live primarily inside my home, not outdoors.

Rolling River Rescue does not give refunds for the return of any Adopted Pet. I understand that any animal entering a new home will need an adjustment period. I agree to give ample time for adjustment. If for any reason I am unable to keep the Adopted Pet, I must return Adopted Pet to Rolling River Rescue.

I will not alter/mutilate Adopted Pet in any way unless deemed necessary for health by a medical professional. This includes De-barking, Declawing, Ear Cropping, Tail Cropping, and Teeth Pulling.

I agree to care for the animal in a humane manner and be responsible animal guardian. This includes supply adequate food, water, shelter, attention and medical care. I agree to abide by the state laws, city, and parish ordinances regarding animals, including licensing my pet with the city in which he/she resides.

I understand and agree that Rolling River Rescue cannot make any warranties or representations concerning the Adopted Pet’s health and temperament. Rolling River Rescue is not responsible for future damages caused by Adopted Pet.

I agree to have adopted pet seen by vet of my choice within 2 weeks of adoption in order to begin any necessary preventatives (i.e. heartworm, intestinal worms, fleas).

I understand and acknowledge that the adoption donation is non-refundable, and will go directly to other animals in need.

Rolling River Rescue's liability is limited to the terms and conditions of this Contract. Adopter understands and acknowledges that Rolling River Rescue has no further responsibility for Adopted Pet once this contract is fully executed by the parties and Adopted Pet is delivered to the Adopter. Adopter understands and acknowledges that he/she/they are not relying on any representations made by Rolling River Rescue to adopt Adopted Pet. Adopter is adopting Adopted Pet under his/her/their own free will and volition and without threat of force or duress and without promise of reward.

I AGREE THAT ALL STATEMENTS I HAVE MADE ON THIS CONTRACT ARE TRUE. IF IT IS FOUND THAT ANY STATEMENTS I HAVE MADE ON THIS CONTRACT ARE NOT TRUE, I HEREBY REVOKE ANY INTEREST I MAY HAVE IN ADOPTED ANIMAL AND SURRENDER ADOPTED ANIMAL TO ROLLING RIVER RESCUE.

Required

Please Type Your Name Below *

By typing your name here, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.

A copy of your responses will be emailed to the address you provided.

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