TEXAS BLESSING RESCUE
Adoption Application
Filling out this application in no way guarantees that you will be approved for adoption. In all cases, the final placement decision is based on the suitability of each pet to the adoptive home. It is our goal to place each animal into the home that is best able to provide for that animal’s specific needs, to provide the adoptive family with the pet that will best fulfill the expectations of that family and to ensure the physical safety of both pet and adoptive family.
Your signature on this form constitutes permission for us to contact personal and veterinary references and to verify information provided, including but not limited to the containment area of the animal.
Signature ______
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Name______
Last First Middle Initial
Address______
Street City, State, Zip Code
E-Mail______Drivers License______
Phone Numbers ______
Home Cell / Fax Emergency
Employer______Work Phone ______
Spouse or Co-Owner’s Name______
Employer______Work Phone ______
Ages of children in the household: ______
Are you 18 years of age or older? Yes No
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Have you considered?
1. Have you considered that this pet may live for 15 years or more? Yes No
Are you prepared to commit to its care for the rest of its life? Yes No
2. If the dog will be around children, have you considered adult size and likely temperament of the dog and how it may interact with small children? (nip if ears pulled, knock them down accidentally, etc)?______
* If the pet is for a child and the agreement is that the child will assist with the care of the animal, what will you do
with the animal if the child does not carry through on his/her end of the bargain? ______
______
3. What will you do if the pet is destructive (chews, digs, claws furniture)? ______
______
4. Are you familiar with crate training? ______Do you have/are you willing to get a crate for this dog? ______
5. Are you comfortable that you have the knowledge regarding the needs and training of this dog? House training, behavior training, grooming, necessary veterinary care? Yes No (If not, please discuss these issues with
shelter staff / volunteers. They will be happy to provide you with information.) Yes No
6. Do you feel your are financially capable of caring for this animal – proper nutrition, vaccinations, heartworm
prevention, flea / tick control, medical treatment? Yes No
TEXAS BLESSING RESCUE
Adoption Application Page 2
Name / Breed of pet you wish to adopt: ______Today’s Date ______
Please bear in mind that TBR is not a profitable agency and receives no outside funding; In order to save these animals, over $20,000.00 in medical, veterinary, health care, food, and other expenses are paid for out of the owners’ pockets each year. The animals are NOT for SALE, but donations are necessary to help offset rehab expenses. With that in mind, what is the adoption donation you’re willing to make toward adopting this pet $______
1. Please list all pets residing in your household during the last five years:
On
Spayed / Vaccinations Heartworm
Type Name Neutered? Where kept? Breed Sex Age Years had? Current? Prevention?
Dog / Cat ______ Yes No In / Out ______ Yes No Yes No
Dog / Cat ______ Yes No In / Out ______ Yes No Yes No
Dog / Cat ______ Yes No In / Out ______ Yes No Yes No
Dog / Cat ______ Yes No In / Out ______ Yes No Yes No
Dog / Cat ______ Yes No In / Out ______ Yes No Yes No
Dog / Cat ______ Yes No In / Out ______ Yes No Yes No
2. Veterinarian name, city and phone: ______
3. Have you taken anyone’s pets other than your own to this vet?______
4. What happened to your previous pets? (Please list and explain) ______
______
______
______
5. Have you ever turned over an animal (other than a stray) to an animal shelter or an animal control officer? Yes No
If so, please describe the circumstances. ______
______
For what reason(s) would you give up or get rid of a pet? ______
______
If it were necessary for you to move, what would you do with your pet? ______
6. How will you prevent your pet from getting heartworms? ______
How will you control fleas and ticks? ______
7. Why do you want to adopt this particular dog? ______
______
______
Is anyone in your family hesitant about adopting this pet? Yes No
Is anyone in your family allergic to dogs? Yes No If yes, how will you accommodate? ______
______
Are you familiar with the breed characteristics of the animal you wish to adopt? Grooming needs, prey drive, escape artist, etc.? Please explain: ______
8. Will this be an indoor pet or outdoor pet? Indoors Outdoors Both
9. Does your house have a fenced yard? Yes No
What type / height fence? ______Have you checked your yard for escape routes? Yes No
If an outdoor pet, is shade available? Yes No Not Applicable
What protection is available when it rains or it is cold? ______
______
10. Are pets allowed where you live? Yes No
If renting, Landlord’s name and phone number: ______
11. What will you do with the dog if you have to be gone for an extended period of time? ______
______
12. Personal reference (not a relative) Name: ______Phone: ______
By signing below, I agree that if I adopt an animal from Texas Blessing Rescue, I will keep it for its entire natural life or turn it back in to TBR. All animals adopted through TBR are microchipped for permanent identification, and the adopter agrees that if TBR learns that an animal has changed ownership (sold or given away) or been neglected (starved or denied medical care) TBS may confiscate and repossess the animal at the adopter’s expense.
Adoption fees are refundable for two weeks from the initial adoption date in an effort to assure the adopted animal fits into its new family. After the two week trial period, fees are not refundable but adopted animals must still be returned if the adopter doesn’t want to continue keeping them.
After the animal is received from TBS, all expenses for its care and all liability for its behavior become the adopter’s. If an adopter wishes to have the animal vet checked after adoption, we encourage them to do so, but the expense incurred is the adopter’s. If a previously undiagnosed health problem is found within the two week trial period, TBS will gladly take the animal back and refund any adoption donation but will not cover any other expenses.
I WILL KEEP THIS ANIMAL FOR ITS ENTIRE NATURAL LIFE OR TURN IT BACK IN TO TEXAS BLESSING RESCUE IF I AM NOT ABLE TO DO SO. I WILL NOT GIVE IT AWAY TO ANYONE (INCLUDING CLOSE FRIENDS OR FAMILY) UNDER ANY CIRCUMSTANCE.
THIS IS A LEGAL CONTRACT EXECUTED IN THE STATE OF TEXAS, AND IS ENFORCABLE IN A COURT OF LAW.
Signed______adopter ______date
Approved______TBS rep______date