Good Dog Rescue Adoption Agreement

Revised 6 February 2009

Good Dog Rescue Adoption Application

Adoption Candidate:

Name of Adopter(s):

Phone:

Do you own or rent?

Do you have children?YesNo

If yes, please list their ages?

Other Pets in the Home

In the space provided, please describe where the pet will be kept during the day and at night and how many hours will the pet be unattended (alone)?

Do you have a fenced yard?Yes___No___

Veterinary Reference:

Vet/Practice NamePhone No.

Personal Reference:

NamePhone No.

What traits in a dog can you NOT tolerate (would return the dog for this reason?)

Good Dog Rescue Adoption Agreement

We agree to pay an adoption fee of ______.We agree to provide a safe home for ______and treat them as a family member.We acknowledge that dogs require annual veterinary visits, vaccinations, dental care and additional medical attention when ill and agree to provide these.We agree to keep this dog on a monthly heartworm preventative as well as a flea and tick preventative and to put a tag on the dog identifying this dog’s name, address and phone number.

We have been informed that our dog is rescued from an animal shelter and as a result, no information is available on his/her previous health history other than the results on current records. We recognize that Good Dog Rescue or Lisa Trenthem will not be responsible for subsequent vet bills. We have assessed this dog’s temperament and behavior in our homeand find the dog acceptable to our lifestyle. We do not hold liable Good Dog Rescue or Lisa Trenthem for problems resulting from the dog’s behavior. Should there be problems within seven days of signing this Adoption Agreement the dog will be returned to Good Dog Rescue with a full refund. If at any time we are no longer able to care for this dog, we will contact Good Dog Rescue to discuss re-homing options.

We acknowledge that this adoption is not final until completion of an in home visit. We further accept that, if at any time in the future, Good Dog Rescue finds we are not providing the care our dog needs as set forth in this agreement or that the information we provided in the adoption application is incorrect, they have the right to void the adoption and reclaim the dog.

Prospective Adopter(s) Signature: ______

Date: ______

Requirements for Adoption Finalization:(Check box when each completed)

Home visit performed on or before ______

Follow-up home visit (if requested by Good Dog Representative) on or before______

Photocopy of valid ID showing correct address where this dog will reside:

Y N (circle one)

Final Adoption Approval:

______

Adopter SignatureDate

______

GDR Representative’s SignatureDate