Be My Forever Home Animal Rescue Effort - Companion Adoption Application/Contract

Be My Forever Home Animal Rescue Effort - Companion Adoption Application/Contract

Date: ______

ADOPTER'S INFORMATION:

Name: ______

Address: ______

City: ______

State: ______Zip Code: ______

Phone #: (h) ______(c): ______(w):______

Email: ______

Age: ____

Occupation: ______Place of Employment:______

Number of adults in household: ___ Children (& ages): ______

Current pets in household:

Name: ______Age: _____ Breed: ______Spayed/Neutered: Y/N

If any are not spayed/neutered, please explain: ______

Heart worm prevention used & date last given: ______

Flea/tick preventative used & date last given: ______

Why do you want to adopt this pet? ______

What characteristics are most important to you in a pet? ______

Are ALL family members in agreement about the adoption of this pet? ___

Where will the pet spend most of his/her time? ______

How many hours a day will the pet spend alone? ____

Will your new pet be restricted from any part of your home? Y/N

If yes, please explain: ______

What is your plan for exercising this pet? ______

Do you own or rent? ______If renting, landlord’s name/#: ______

Do you have a fence? Y/N If yes, what type / height? ______

Do you have a pool? Y/N If yes, is it protected? Y/N

Are you prepared financially for the responsibility of having a pet? Y/N

What will you do if your pet displays destructive behavior? ______

Who will care for this pet when you’re out of town? ______

If you had to relocate, what would happen to this pet? ______

Have you ever surrendered a pet to a shelter or rescue? Y/N

If yes, please explain: ______

Any other information you think may be relevant: ______

Vet Reference: ______

Personal References - please give 3:

Name: ______Relationship: ______Phone: ______

ADOPTER'S AGREEMENT

· I agree that the animal is being adopted for myself and will not be sold, adopted, or given to another party. ______(initial)

· I agree that the animal will not be allowed outdoors without proper supervision. When taking my dog outdoors, they will be on a secure collar & leash and wear proper ID. My dog will never be allowed outside unconfined & unsupervised. ______(initial)

· (If adopting a cat) I agree that I will not declaw the cat or allow the cat outdoors. ______(initial)

· (If adopting a dog) I agree that this dog is to be a companion animal, not a guard dog. The dog will live inside my home, not outdoors. _____ (initial)

· I agree to care for the animal in a humane manner and be a responsible animal guardian. This includes supplying adequate food, water, shelter, attention, and medical care. ______(initial)

· I agree to provide the adopted pet with necessary vaccinations at the intervals advised by my veterinarian and other medical care, preventative medications and grooming as needed. I authorize my veterinarian or clinic to release all medical records in regard to this pet to the rescue at any time. ______(initial)

· If at any time I find I cannot keep the pet for any reason, I understand I must return the pet to BMFH Rescue. ______(initial)

· I understand and agree that the current rescue makes no guarantees about the animal's temperament and is not responsible for future damages or injuries caused by the animal. ______(initial)

· I give the current rescue permission to call me at any reasonable time to assure that the animal is being properly treated and cared for. ______(initial)

· I agree that all statements I have made on this form are true. If it is found that any statements I have made on this form are not true, or any failure to perform the foregoing agreement, the adopted animal can be confiscated. ______(initial)

· I agree that the adoption donation of $_____ is non-refundable even if the dog is returned to BMFH Rescue, and that BMFH Rescue is adopting not selling this pet to me. ______(initial)

· I agree that I will never sell, trade, or give away this pet to anyone. I will never relinquish this pet to any shelter or pound. I will notify BMFH Rescue if I am unable or unwilling to keep this pet, and I will return this pet to BMFH Rescue. lf this pet should become lost or stolen, I will notify BMFH Rescue within 24 hours. ______(initial)

· I agree that all future medical treatments are my responsibility, unless BMFH Rescue has agreed to pay for them in this contract as noted: ______

· I agree that if this animal is unaltered, I will have the animal spayed/neutered within _____ days. I understand that failure to get this animal spayed/neutered within the specified time frame will result in forfeiture of my animal and any adoption donation given. I will also be subject to pay a $100 administration fee as well as face possible legal action. ______(initial)

· I will buy and use a crate if needed and/or advised. The dog will be primarily indoors interacting with our family, not to be banished to the backyard. I will never tie my dog to a chain or leave him/her unattended for long periods of time. This is a companion animal, not a possession. I will not transport this animal unconfined in an open vehicle. ______(initial)

· I will protect this pet with annual vaccinations and routine medical care as recommended by a veterinarian. Dogs must be kept on monthly heartworm preventive year round. I will seek immediate veterinary care if this pet becomes ill or injured. ______(initial)

· If it is recommended by a veterinarian to euthanize this pet, approval must be obtained from BMFH Rescue PRIOR to the procedure. ______(initial)

· I will comply with all state and local ordinances in the confinement, care, and licensing of this pet. I will reclaim this pet promptly and pay any required fees if it is picked up by an animal control agency. ______(initial)

· I agree to allow a visit/call by any BMFH Rescue representative at a mutually agreeable time at any time after this adoption to verify the wellbeing of this animal. ______(initial)

· I understand that BMFH Rescue makes no guarantees regarding the age, nature, temperament, or health of this pet. By signing this contract, I assume all risk and responsibility of ownership of this pet once it is in my possession. I agree to defend, indemnify, and hold harmless BMFH Rescue and its representatives against any and all claims including claims of property damage and/or personal injury, which arise from my adoption of this pet. ______(initial)

· I agree that if I fail to comply with the terms of this contract, I will voluntarily relinquish this pet to BMFH Rescue. ______(initial)

· I agree to pay all court costs and attorney's fees incurred by BMFH Rescue if necessary to enforce this contract. ______(initial)

· I agree to contact BMFH Rescue of address and phone number changes. ______(initial)

Adopter's Signature: ______Date: ______

BMFH Rep Signature: ______Date: ______

1 / Contact info: (615) 540-8448
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