BLACK CATS & OLD DOGS ANIMAL RESCUE, INC ADOPTION APPLICATION AND AGREEMENT

Name:

DL#:

Home Phone:

Work Phone:

Address:

Email:

Rent/ Own:

Landlord Name & Number:

Veterinarian Name & Number:

Animal you are Interested in Adopting:

Does your landlord allow this type and breed of animal in your home?

Do you have experience with this type/ breed of animal? Please Explain:

What types of animals do you have in your home? What are their ages and breeds?

Are your animals up to date on shots, on heart worm prevention, and spayed/ neutered? If no, please explain:

Are there any children in the home where the pet will live? If yes, please list ages.

How many adults live in the home where the pet will live? Is everyone in agreement to adopting a new pet?

Do you have a fenced yard? (Dogs only)

Where will the animal be kept when you are not home?

If you move, what do plan on doing with your pet(s)?

Do you understand that it may take several weeks for your new pet to settle in? Do you agree to give your new pet a chance to get used to your home and family before considering returning the pet?

Why are you interested in this particular animal?

What lifestyle do you wish your new pet to have?

What will happen to the animal if you have any children?

Are there any concerns about this animal that you would like us to address for you?

  1. I promise to be a responsible owner and provide adequate food, water, and veterinary care for the animal that I am adopting from Black Cats & Old Dogs Animal Rescue.
  2. I promise that my new pet will be spayed/neutered by the following date and I will provide proof of spay/neuter within one week of the procedure (leave blank if animal is already fixed). ______
  3. I will never harm this or any other animal in my care. I will not allow others in my home to harm this animal or any other animal in my care.
  4. (Dogs) I will never leave my dog tied up for more than one hour at any given time.
  5. (Cats) I will never have my cat declawed
  6. If I move, I promise that I will make every effort possible to take my new pet with me.
  7. I will never abandon my new pet. If a circumstance arises in which I cannot keep my pet, I will notify BCOD immediately.
  8. I promise to update my new pet's microchip with my contact information and keep BCOD as a secondary contact, so that if my pet is lost, they will be able to help.

◦If my new pet does not have a microchip, I promise to get him/her micro chipped at the time of spay/neuter and list BCOD as a secondary contact.

  1. If the animal goes missing, I will notify BCOD immediately.
  2. If the animal dies, I promise to notify BCOD within seven days.

***I understand that failure to perform the foregoing will constitute a breach of contract. In the event of any such breach of contract, I authorize BCOD to reclaim

possession of the adopted animal***

Adoption fees are refundable for seven days. If you wish to return your new pet after seven days, your adoption fee will not be refunded.

Name (Printed):

Signature:

Date:

BCOD Signature:

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FOR BCOD USE ONLY

Home Check:YN

Landlord Check:YN

Fee Paid:YN

Approved:YN

Reason(if denied):