APPLICATION FOR ADOPTION

911 DOG RESCUE INC.

NON-PROFIT 501c-3

NAME:______PHONE:______

ADDRESS:______EMAIL:______

Please answer the following questions honestly and thoroughly. Thank You.

  1. Dog(s) you are applying for? ______
  2. Past dogs you have owned. How long? Where are they now? ______
  3. Have you ever surrendered an animal? If so, why? ______
  4. Do you rent or own your home? ______Rent ______Own (if renting, homeowner must sign and agree to the terms of adoption)
  5. Do you have a fenced in yard? _____ Yes _____ No
  6. Do/did you treat your dog(s) with flea/heartworm preventative? _____ Yes _____ No
  7. Where in your home is your dog welcome? (Will you confine them?) ______
  8. Have you kept up to date on all vaccination with past and current pets? _____ Yes _____ No
  9. Please provide a list of people in your home and their ages if under 18 years old.

______

  1. Veterinarian’s Name:______Phone:______Address:______
  2. Please provide the name, relation and phone number of three personal references.

1. ______(______)(______)______-______

2. ______(______)(______)______-______

3. ______(______)(______)______-______

  1. Our adoption fee is $250.00-$300.00 per dog – there is a small discount if adopting multiple. Adoption fee includes all age appropriate vetting, spaying/neutering and micro-chipping.
  2. Please know if our Vet Dr. Doles or PetFix, Ohio, are not used for alter (spay or neuter), the expense is then adopter's Responsibility. ______PLEASE INITIAL

PLEASE READ THE FOLLOWING TERMS & CONDITIONS

  • Dogs 6 months and older are subject to a trial period. A non-refundable $25.00 fee is mandatory for a trial period. If you adopt, it will be deducted from adoption fee.
  • After a 7 day trial period (dogs 6months+), your adoption fee is expected in full. Once payment is made it is non-refundable.
  • 911 Dog Rescue Inc. relinquishes any and all responsibility of said dog once you take the dog into your possession. This includes but is not limited to furniture, home interiors, etc., or any behavioral issues.
  • 911 Dog Rescue Inc. reserves the right to perform a home check before an adoption is finalized and also at any time after the adoption is finalized. 24 hours notice will be given before a home check after a finalized adoption. If the pre-adoption home check is not up to par per Amy Beam, 911 Dog Rescue Inc. reserves the right to deny the adopters until the issues are resolved or deny them indefinitely. If a home check is performed after the adoption is finalized, Amy Beam will review any issues and the dog may be removed from the adopters if the dog is in danger. At that time, the dog will not be returned to the adopters and the adoption fee will not be refunded.
  • By signing, you promise to be a responsible pet owner by feeding and watering, flea treating and caring for your dog as it is going to be a part of your family.
  • Upon final adoption, you MUST have a county dog license and a SECURE name tag with your current home address and phone number.
  • All 911 Dog Rescue Inc. dogs have a Health Certificate and have been tested and are heartworm negative, rabies vaccinated (if proper age) and are up to date with shots. You will receive records upon final adoption. I do everything in my power to ensure the health of these dogs but I am NOT a vet and I cannot guarantee health.
  • For your protection, 911 Dog Rescue Inc. encourages a vet appointment be made with your vet within a two week period AFTER final adoption and IMMEDIATELY be put on heartworm preventative.
  • Please know by adopting from 911 Dog Rescue Inc. you become part of a family of well over 500 dogs saved in the past 5 years who have been successfully adopted.
  • Please know your donation (adoption fee) is used specifically to help save other animals. We often have dogs surrendered with no vetting at all, not to mention they are rarely fixed. We also work with a local animal food pantry that we help to supply low-income families with needed supplies. Thank you for helping me help them.
  • If for ANY reason you cannot keep this dog, it is to be returned to 911 Rescue. Please initial here to show you understand and agree to this term of adoption. ______

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By signing below you agree to above terms and conditions:

Signature of Adopter: ______Date: ______

Signature of Homeowner: ______Date: ______

Rescue Representative:______Date: ______

Please know; if payment is not received other dogs cannot be saved. This rescue counts on your honor as a client. All of my fees are directly used to help save more dogs and to also provide the food pantry with needed animal related items!

Please complete this application and email it to

or it can be mailed to:

911 Dog Rescue Inc.

33915 Roberts Rd. Eastlake, OH 44095

ANY QUESTIONS, PROBLEMS, CONCERNS OR COMMENTS CAN BE FORWARDED TO THE FOLLOWING:

Amy Beam – CEO/President & Founder: (440) 289-1515