ROCK 'N PAWZ DOG ADOPTION APPLICATION
In order to be considered for an adoption, you must: Be 21 years of age; have the consent and knowledge of all adults living in your household; have a valid I.D.; and have the landlords name and telephone number if renting. Please understand that ROCK 'N PAWZ RESCUE must approve your adoption application prior to adoption finalization. (*indicates questions that must be answered in order to submit the application)
Email
First Name
Last Name
Driver's License # and State of Issue
Address: Please include City, State & Zip Code
Home Phone
Cell Phone
Name of Pet you are interested in:
Please indicate all the reasons you are interested in this pet:
Companion
Family Pet
Gift
Other
If you checked other, please explain here:
Do you live in a:
House
Condo
Apartment
Mobile Home
Do you:
Own
Rent
Does your rental or lease agreement permit pets?
Yes
No
Are there any restrictions/Home Owners Association? Please explain here:
Name and Phone Number of Landlord/Leasing Office
Do you have a fenced yard?
Yes
No
If yes, please describe height and type:
Please provide the following information about your household.
Number of Adults
5
Number of children. Please also list their ages.
Is anyone in your family allergic to animals? If so, who?
Where will your pet be during the day?
Select an option
Indoors
Outdoors
Crate
Garage
Other
If you checked other, please explain:
Where will your pet sleep at night?
Is anyone home during the day? If yes, who?
Are all your family members aware that you are considering adopting a pet?
Yes
No
Do they approve of you adopting a pet?
Yes
No
Not sure
Is this pet a gift surprise?
Yes
No
How much $ do you expect to spend on this pet, per year (including medical expenses)?
What arrangements do you plan to make for your pet when you travel?
Please tell us the breed, size and age of any other pet you currently have in your home:
Are they spayed/neutered/vaccinated?
Yes
No
If you answered "no" to the question above, why not?
Have you owned any pets in the past?
Yes
No
If you answered "yes", what happened to them (Died of old age; hit by a car; gave them away; etc.)?
If your current living conditions were to change (i.e., move, change jobs, divorce, etc.), what would you do with this pet?
Under what circumstances would you feel it necessary to give up this pet? Choose one or more.
Pet barks or whines
Loss of job/income
Pet becomes very ill/old
Pet becomes aggressive
Pet has a potty "accident" in the home
You move to a different state
Pet damages property (i.e.: carpet, furniture, etc.)
Divorce/Marriage/New partner doesn't like pet
I would never give this pet up for any reason
Other
If you answered "other", please explain:
Name and phone number of current veterinarian (if you do not have one, please answer, "currently do not have a veterinarian"
Are you willing to commit to a training class/program with this pet if required?
Yes
No
Do you understand that rarely will anyone know whether or not a pet is housebroken in a new environment?
Yes
No
Do you plan to train this pet?
Yes
No
How long are you willing to give this pet to settle in and bond with you, your family and other pets in his/her new home?
If "yes", how
How do you plan to discipline this pet?
Part II: ROCK 'N PAWZ Initial Rules and Policies Agreement
Please read and check each statement below.
I understand that 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
Agree
I am financially able to provide for the animal's needs. This includes food, supplies, shelter, veterinary care, heautworm, flea, tick and parasite prevention; which can add up to approximately $800 per year.
Agree
I have adequate time to spend with my new pet, including time for training exercise and grooming.
Agree
I understand that if I move, my pet will make the move with me.
Agree
I understand that I must comply with all state and local ordinances concerning pet licenses and vaccinations.
Agree
I understand that there may be additional requirements set fourth based on which per is chosen and the nature of the pet's personality, needs, dislikes, etc.
Agree
I understand that this pet must be returned to ROCK 'N PAWZ RESCUE for any reason I am no longer able to care for him/her
Agree
This pet shall never be given away, sold, transferred, abandoned or neglected by you at any time, for any reason.
Agree
This pet shall never be given away, sold, transferred, abandoned or neglected by you at any time, for any reason.
Agree
ROCK 'N PAWZ RESCUE reserves the right to reclaim this pet should the contract agreement be broken or violated by you.
Agree
I agree to routine follow-up post adoption.
Agree
The microchip must always be updated if you move and you agree to always list ROCK 'N PAWZ RESCUE as a secondary contact in case of crisis, death, disaster, incarceration etc.
(This is a precautionary measure to help you and insure safe release of the pet from authorities, if needed)
Agree
I understand that I am adopting an animal that may not be altered or fully vaccinated yet. I am responsible for continuing vaccines and altering of pet.
Failure to comply can result in ROCK 'N PAWZ RESCUE our adoption.
Agree
I agree that this document will become part of the adoption records should I adopt a pet form ROCK 'N PAWZ RESCUE
Agree
DISCLAIMER AND TERMS AND CONDITIONS
* All of the information I have provided is true and complete. * I agree to follow the rules and policies that ROCK 'N PAWZ RESCUE has set forth here. * I understand that it is my decision whether or not to adopt any particular pet. * I will not hold ROCK 'N PAWZ RESCUE responsible for any damage, injury or harm caused directly or indirectly to any person or property by any pet I may decide to adopt. ROCK 'N PAWZ RESCUE AT ITS SOLE DISCRETION RESERVES THE RIGHT TO REFUSE ANY APPLICANT FOR ANY REASON OR NO REASON. I have read the disclaimer and agree to the terms and conditions.
Your Signature
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