Adoption Application
The person or persons submitting this application will henceforth be known as the, “adopter”. The potential rescue animal will be known henceforth as the, “pet” or the “adopted pet”. The rescue group or person where this adoption application is submitted will be known henceforth as, “Sadie’s Safe House Chihuahua Rescue”. The adopter must take full responsibility to insure that arrangements are made with Sadie’s Safe House Chihuahua Rescue if a situation arises where the adopted pet can no longer be cared for by the adopter as stated below.
Name:
Your answer
Address (Please include city, state and zip code):
Your answer
Phone Number:
Your answer
Email Address:
Your answer
Is there a particular pet you're interested in? If so, please provide a first and second choice.
Your answer
Are you over the age of 18?
How long have you lived at this address?
Your answer
Do you plan to move in the near future?
Do you live in an apartment or a home?
How many adults and children are in the home?
Your answer
If there are children, what are their ages?
Your answer
Do you own or rent? Renters will need to submit a copy of your lease or a notarized statement from your landlord stating that a pet of this breed and size is permitted.
If you move, what will you do with the adopted pet?
Your answer
Please list all of the animals currently in the household. Include species, breed, sex, if they are neutered/spayed and if they are current on vaccinations.
Your answer
What is your occupation?
Your answer
Where will the pet be kept during the day?
Your answer
Where will the pet be kept at night?
Your answer
Where will the pet be kept when no one is home?
Your answer
How long will the pet be left alone each day?
Your answer
Who will have the main responsibility of caring for the pet?
Your answer
Where will the pet exercise and relieve itself? Select all that apply.
Have you ever lost a pet or had a pet die at an early age because of an accident? If yes, explain.
Your answer
Have you ever given up a pet? If yes, explain.
Your answer
How much do you expect to spend on the adopted pet (Food, Grooming, Vet, etc.)?
Your answer
Which sex would you prefer?
Which age would you prefer?
Would you consider a pet with health problems?
Will you consider a pet that is not considered to be house broken?
Is size or weight important? If yes, explain.
Your answer
Is appearance important? If yes, explain.
Your answer
Do you agree to return this dog to Sadie’s Safe House Chihuahua Rescue if you are unable to keep it for ANY reason? If no, explain.
Your answer
Please provide the name, address and phone number of your primary veterinarian.
Your answer
Please provide the name, phone number and email address of 2 references.
Your answer
Sadie’s Safe House Chihuahua Rescue or their representative reserve the right to refuse any application for any reason.
Adoption Contract Terms
By filling out, signing and submitting this application, I/we certify that all of the information on this application is true and complete. I/we understand that if selected as an adoptive home I/we will comply with the following conditions of adoption:
I. Adopter shall keep adopted pet as an indoor pet with outdoor privileges and will provide the adopted pet with identification at all times (Example: Collar, Tag, Tattoo, Microchip, etc.). The adopted pet will be kept under control at all times, on leash or in a crate, when off adopter’s property.
II. Adopter shall provide adequate veterinary care for the adopted pet including annual vaccinations, rabies vaccinations as needed, and any other care recommended by the adopted pets’ veterinarian. Adopter will take pet to the veterinarian if ill. If adopter is unable to do so, the adopter will notify Sadie’s Safe House Chihuahua Rescue as soon as possible.
III. Adopter agrees to notify Sadie’s Safe House Chihuahua Rescue of any change of address or telephone number of adopter.
IV. If the adopted pet is lost or stolen, the adopter will immediately notify Sadie’s Safe House Chihuahua Rescue.
V. Adopter shall return the adopted pet to Sadie’s Safe House Chihuahua Rescue if, under any circumstances, adopter is no longer able to keep or provide for the adopted pet. Adopter shall not sell, give, otherwise transfer, or convey the adopted pet to anyone other than Sadie’s Safe House Chihuahua Rescue.
VI. If unaltered at time of adoption, adopter shall have the adopted pet spayed/neutered within 30 days of adoption date and have veterinarian mail or email confirmation of procedure on or before this date. If not, the pet will be repossessed without the refund of any adoption fees.
VII. Adopter agrees that I/we will allow representatives of Sadie’s Safe House Chihuahua Rescue to check the pet and its environment, unannounced at any time. If at any time, the placement is found to be detrimental to the pet's health, mental or physical well-being, Sadie’s Safe House Chihuahua Rescue reserves the right to remove the adopted pet from said placement until the situation is corrected or until another placement can be made without refunding adoption fees.
VIII. Adopter agrees to RELEASE OF LIABILITY AND INDEMNITY: I/we promise and agree to be solely responsible for the adopted pet. To indemnify and hold harmless Sadie’s Safe House Chihuahua Rescue, their agents and representatives, members, successors or assigns from any and all claims of liability. This includes all liability and indemnity for any conduct, behavior, damage or injury caused by the adopted pet to any person or property; from any claim or damages known or unanticipated resulting from any claim or damages arising by my/our ownership or control thereof. Sadie’s Safe House Chihuahua Rescue is not liable for acts of the adopted pet after placement with adopter.
IX. Adopter understands that there is no health warranty given with the adopted pet. If he/she develops an illness or injury after adoption, or is discovered to have an illness not discovered before adoption, the adopter is responsible for treating that illness/injury.
X. Adopter also understands that Sadie’s Safe House Chihuahua Rescue derives its only source of funding through donations and fund-raising activities. The adoption donation for this animal is considered NON-REFUNDABLE, even if the animal is returned to the rescue at any time.
XI. Adopter understands that, in the event the adopter breaches any covenant or condition herein and incurs any legal costs, including any attorney's fees, costs of litigation, costs of deposition, witness fees for expert or non-expert witnesses, court costs; or any other expense in relation to the enforcement of any covenant or condition, the adopter shall be individually and jointly liable therefore to Sadie’s Safe House Chihuahua Rescue.
XII. ADOPTER REPRESENTS THAT NO MEMBER OF HOUSEHOLD HAS EVER BEEN CHARGED WITH CRUELTY TO ANIMALS.
XIII. Adopter certifies that all of the above information is accurate and complete. I/we understand that if selected and adopting a pet from Sadie’s Safe House Chihuahua Rescue, I/we must comply with the above stipulations or forfeit the pet back to Sadie’s Safe House Chihuahua Rescue without refund of adoption fees.
By initialing here, I hereby certify that I have read the above Adoption Application Contract, fully understand all that I have read, and I agree to each and every outlined term and condition for the adoption of the pet.
Your answer
Electronic Signature
Your answer
Disclaimer
The answers you give on this application will help us find the best possible match between you and the pets available for adoption. Remember, we are searching for the perfect home for each individual pet. You may have a perfect home for one pet, but not another. This is not an overnight process, we are volunteers and don’t always have available pets, so please expect some waiting time to be involved. Please make sure all questions are answered as truthfully and completely as possible. If any information is omitted, the application will be discarded. We reserve the right to inspect the prospective home environment both before and after adoption without any advanced notice. In addition, if we discover that any information on this form was knowingly falsified, we reserve the right to take the pet back into our possession. PLEASE NOTE: If your application is approved, we will require a donation at time of adoption of up to $450 to defray the ever-increasing costs of veterinary care for our rescued pets. In addition at time of adoption, you will be required to sign a contract committing to the care of the pet.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy