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Adoption Form 
If you are interested in adopting a dog, please fill out the follow questions.
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Name (first and last name) 
Address: 
Phone number 
License number 
Dog you are interested name (name, color, age) 
Do you currently live in? 
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Do you currently?
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How long have you lived at your current residence?
Does anyone in the home have allergies? If yes, what are they?
How many adults/children live in your home? What are their ages? 
Who will be primarily responsible for taking care of the dog? 
Is this dog a gift? 
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What is your reason for wanting this dog specifically? 
How many hours a day will the dog be alone? 
Where will the dog be kept when you are not home? 
Do you have a fenced in yard? If yes, how tall? 
Are there other pets in the home? If yes, what are their ages? Are they vaccinated? Are they spayed/neutered? 
Do you have a current veterinarian? If yes, please list name, address, phone number.
Under what circumstances would you not keep this dog? 
What size dog are you looking for? 
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My ideal dog would be.....

Return Requirement

The Adopter agrees that if, at any time, they are unable or unwilling to continue caring for the Dog, the Dog must be returned to Pipers Paw’s Rescue Inc.  The Adopter may not rehome, give away, sell, or otherwise relinquish the Dog to any person or organization without the Rescue’s express written consent. Acknowledgement of Obligation

By signing this Adoption Agreement, the Adopter acknowledges and agrees that this obligation is binding. 

No “ifs, ands, or buts” — the Dog must be returned to the Rescue.

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