Companion Animal Adoption Application

Southern Pug & Boston Terrier Rescue

Division of Harlee’s Angels

864-505-5442

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COMPANION ANIMAL ADOPTION APPLICATION

Date:______/______/______
*Adoption Fee:

*if you are approved to adopt, please note we do not accept personal checks. Adoption fee can be paid in the following ways: PayPal, Money Order or Cash.

APPLYING FOR:

What type of personality are you looking for?

APPLICANT'S INFORMATION:

EMPLOYMENT:
Employer: ______
Occupation: ______
How long at your present job? Years______Months______
Can you be contacted at your job? Y _____ N ______
If yes, work phone #: ______-______-______

REFERENCES: Please list people other than family who you have known for at least 5 years.
Name: ______Phone Number: ______
Name: ______Phone Number: ______
Name: ______Phone Number: ______

HOUSEHOLD INFORMATION:

Where Do You Live? (Please check one)

How long at your present address?

Years______

Months ______

If you decide to move in the future, what will you do with your companion animal?

What provisions have you made for your companion animal in the event of your illness or death?

Many people believe their family member or friends will take care of their beloved animals. Many animals are taken to the local shelter, most shelters are high kill and surrendered animals are the first to be killed for space. Please make sure you have spoke to your family and place the name of the family member or friend that has agreed to take your animal in your will.

QUESTIONNAIRE:

If necessary, how will you discipline the animal?

Maximum time pet will be alone per day.

Reason or Interest in Adopting:

Do you have a fenced in yard: Y____ N ____

OTHER ANIMALS:

VETERINARIAN INFORMATION:

List each Vet, Animal Hospital or Clinic where your animal or animals receives/has received care. Please contact your vet and advise that Southern Pug & Boston Terrier Rescuewill be calling for a “Vet Check” and give your permission for them to speak with our representative.

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Yearly Cost

The range in yearly cost for food and inoculation's for a healthy dog is approximately $500-750. More should there be an injury or illness. Are you prepared to bear this minimum expense?

Yes I understand the commitment ______(Please initial)

An authorizedSouthern Pug & Boston Terrier Rescue representative will inspect the premises where the animal will be kept both before, and after adoption. Also approximately 3 home visits will be made during the course of the first year of adoption. Do you have an issue with this? Y___ N_____

(If Yes please explain why)______

Please Sign each statement below:

1. The Adopter represents that he/she has never been subject to legal action for cruelty to or neglect of animals. The Adopter further represents that he/she has never owned an animal which has been confiscated by any animal control or humane organization for violations of state or local animal control regulations or animal adoption agreements. ______
2. The Adopter agrees to informSouthern Pug & Boston Terrier Rescueif they ever intend to euthanize the animal for any reason,Southern Pug & Boston Terrier Rescueretains the right to take possession of the animal if they disagree with the reason and/or decision. *Note: This does not include situations where a Veterinarian has deemed it necessary to euthanize the dog due to irreversible illness. ______
3. The Adopter agrees to notify Southern Pug & Boston Terrier Rescuewithin fourteen (14) days of a change of address or phone number, for a period of one (1) year post-adoption. ______
   *I hereby certify that all information supplied by me on this application is true. Any information supplied on this application knowingly incorrect will result in IMMEDIATE DENIAL of our adopters. If you are denied you will not receive a call, nor will you be informed as to why this decision was made. We are looking for “forever” homes and not temporary bounce houses. Please be sure you are ready for this life-long commitment before you sign our application.*
   Signature: ______Date: ______
   Print Name: ______Date: ______
   

Once you are approved to adopt, it’s your responsibility to make appropriate transport arrangements. We will work with you to make arrangement to get the dog to you, however we cannot guarantee volunteer transport. You are responsible for picking up your new family member. We do not cargo ship dogs. We allow only certain paid transport companies to drive the dogs, at your expense, not the rescues. WE MUST APPROVE THE PAID TRANSPORT COMPANY. There are several transport companies that we know that have decent prices and will be happy to give you there contact information. Paid transports require health certificates at the cost of $45, which is your expense. Once you are approved and agree you want to adopt the dog listed, you must pay the full adoption fee in order for the dog to be removed from petfinders and placed as adopted. Until the adoption fee is paid, the dog is still considered available for adoption.

********FOR OFFICE USE ONLY********

Adoption Fee:______

Reviewed by:
Date:
Driver’s license or other formal ID Verified: Y/N
Housing verified: Y/N
Date:
Comments:

Landlord Approval: Y/N
Date:
Comments:

Veterinary Reference Checked: Y/N
Date:

Comments:

***Final Approval***
YES / PENDING / DENIED

Date:
Animal Description: -
Sex: M/F Age:

Animal's name: