Rescue Me-Purebred K9 Rescue, Inc.
of Central New York
Karen Trunfio, Adoption Coordinator – (315) 271-5234
Mary Cooper, Director – (315) 281-6009
CANINE ADOPTION APPLICATION/CONTRACT
As a non-profit animal welfare group, our goal is to promote responsible animal care and prevent the abuse and suffering of companion animals. We will personally screen applicants in order to determine if the needs of a specific rescue animal fits the lifestyle expectations of the potential owner. This method has proven successful to save more homeless or relocating animals and reduce the risk of failed adoptions. Completing this application does not guarantee adoption approval. Please complete this application and return via Email or US mail. Allow us at least three business days to process this information and contact your references. We will be contact you during this process concerning any questions we may have. Your patience is greatly appreciated! (Use additional sheet if needed.)
Today’s Date:
Name, ID#, and Breed(s) of dog you wish to adopt:
Your Full Name: DOB:
Spouse/Roommate’s Name: DOB:
Street Address:
City/State/Zip Code/County:
Home Phone: Cell Phone:
Email Address:
Your Occupation: Work #:
Spouse/Other’s Occupation: Work #:
Do you?
How long have you resided at your current address?
If less than one year, please give previous address:
If renting, landlord’s Name & Phone #:
If renting, we will need a statement from your landlord giving his/her permission for you to have at dog at the above address.
Are you planning to move soon? If yes, when and where?
Check which best describes the area in you live:
Check type of home:
Does anyone in your home have known allergies? If yes, please explain:
Number of children residing in the home: Ages:
Adults residing in the home: Relationship:
Are all members of household in agreement to adopting a dog/puppy?
Do all members of the household work?
How many hours will the dog be home alone?
List any pets currently living in your home:
Pet’sName / Dog/Cat
&
Breed / Age
Sex / Spayed/
Neutered / Inside/
Outside/
Both / Where did you acquire this pet? / # of Years
Owned
**If you have any additional pets, please list them below:
List any pets you NO LONGER have:
Pet’sName / Dog/Cat
&
Breed / Spayed/
Neutered / Inside/
Outside/
Both / When did you
Have this pet? / Where is this pet now?
Yes / InsideOutsideBoth
Yes / InsideOutsideBoth
Yes / InsideOutsideBoth
If you have had additional pets, please list them on a separatesheet using same format.
Name of Current and/or Past Veterinarian(s):
Vet’s Phone #: # of Years Known:
Please notify your veterinarian that we will be calling so they will release information.
What type of dog are you looking to adopt: Indoor/house: Outside:
Gift: Child’s: Hunting: Companion for other dog/cat: Protection:
Rate the activity level of your home: Quiet: Busy/Frequent Visitors:
Active family with kids: Very busy/sometimes hectic:
Is this your first experience with a dog?
If yes, have you researched dog and/or puppy care?
Do you have a fenced in area for the dog/puppy? Size:
If no, which of the following do you plan to use? Electronic Fencing: Tie Out:
Cable Runner: Chain/Dog House: Garage: Outside Kennel:
Run Free:
Do you know how to crate train a puppy/dog?
Do you know how to housebreak a puppy?
When you are home, where will the dog be kept? (i.e. kitchen, living room, bedroom, laundry room, basement)
Where will the dog/puppy sleep at night?
When no one is home (i.e. work, shopping), where will the dog be kept (be specific)
What arrangements have you made for the dog while you are away or on vacation?
Are you familiar with canine heartworm disease and preventative?
Are you familiar with Animal Control ordinances and required licensing in your area?
Have you ever taken a dog to obedience classes? Yes No
Are you planning on taking this dog/puppy? Yes No
Do you understand the financial cost of owning a dog? Yes No
Are you taking this dog/puppy for a vet visit
withinone month of the adoption? Yes No
Are you familiar with introducing your new dog to
the children & current pets residing in your home? Yes No
(Dogs may experience stress or confusion in their new environment, please be patient and give the dog time to adjust.)
Would you agree to a “home visit” by a volunteer to your home prior to and/or after adoption (by appointment only)? Yes No
Puppy Adopters – you will be legally obligated to have the puppy spayed/neutered by the age of 6 months and provide us with a copy of the spay/neuter certificate for our files. Are you willing to comply? Yes No
References: Please list at least three references that are familiar with your family and lifestyle (only one relative please).
Name: Relationship:
Address: City/State/Zip:
Phone #: Cell #:
Name: Relationship:
Address: City/State/Zip:
Phone #: Cell #:
Name: Relationship:
Address: City/State/Zip:
Phone #: Cell #:
Please take a moment to review your application. Missing or unclear information may delay or prevent approval. Please read the following page carefully as this is your contract you will sign upon adopting a dog.
I have read the above information carefully and have filled out this application to the best of my knowledge. I understand that omission of information and/or failure to answer all questions honestly can result in this application being declined. I give “Rescue Me” and its associates’ permission to fully investigate the information provided, as well as contact veterinarians and related persons and officials. In addition, I understand the adoption decision is dependent on many factors, including but not limited to, the compatibility of the family and home to the individual animal, and other applications received on this animal.
By signing this contract, I attest and swear that all information is accurate and true to the best of my knowledge and that I have never been charged or convicted of animal abuse, neglect or maltreatment.
All dog adoption contracts approved by Rescue Me–Purebred K9 Rescue, Inc., are subject to the following terms and conditions:
1.The Adopter (herein known as the individual adopting the said name dog) agrees that the dog will be kept only as a domesticated house pet. This means that the dog will be kept indoors, as a part of the family, except for periods of exercise in a fenced-in area or on a leash.
2.The Adopter agrees to adhere to all local licensing requirements for the dog. The Adopter will be given proof of spaying/neutering and rabies vaccination in order to obtain the licensing. The license must be obtained and a copy presented to RescueMe.
3.In the case of adopting a puppy and the puppy has not been spayed/neutered, the Adopter agrees to have said puppy spayed/neutered by seven months of age and to provide Rescue Me with such documentation that the procedure has been completed by their veterinarian. Further, licensing of the puppy must be obtain according to local licensing requirements (usually one year of age). Proof of licensing should be sent to RescueMe.
4.The Adopter grants Rescue Me the right to make periodic scheduled visits to the Adopter’s premises for the purpose of checking on the general health and welfare of the dog and to assure that spaying/ neutering/licensing has been adhered to according to the terms and condition of this agreement.
5.The Adopter herein states that he/she is 19 years of age or older and that all family members are in agreement with this adoption, and to their knowledge, no one in the home is allergic to dogs.
6.The Adopter represents that he/she has never owned an animal which has been confiscated by the Animal Control Officer or Humane Society in violation of state or local animal control regulations or animal adoption contracts.
7.If the Adopter is leasing an apartment, he/she agrees to provide written permission, along with a phone number of the landlord, allowing the dog to reside in the apartment.
8.If for any reason the Adopter is unable to provide care for the dog, the Adopter agrees to return said dog to RescueMe. The Adopter shall not offer the dog for sale or give the dog to any third party without prior written consent of RescueMe.
9.The Adopter agrees that Rescue Me shall have the right to immediate possession of the dog if, in the judgment of Rescue Me, the dog is receiving inadequate care, being improperly housed or handled, or has not been spayed or neuter on or around the date agreed as of the signing of this contract.
10.The Adopter agrees to pay Rescue Me the sum of $300.00 as liquidated damages in the event the terms of this contract are breached. This liquidation of damages does not bar Rescue Me from seeking return of the dog by judicial process and/or other legal means if necessary.
11.The Adopter hereby declares that they have been made aware that a dog’s behavior/personality may change after it leaves Rescue Me and accustoms itself to their new home and environment. And, further, Rescue Me makes no representations or warranties as to the temperament, health, or mental disposition of any dog put up for adoption.
12.The Adopter fully understands and agrees that there will be NO REFUND OF THE ADOPTION FEE should the adoption not be successful. We make every effort to place our dogs in permanent homes whereby they will not be returned, as this can cause undo stress on the dog.
13.The Adopter hereby accepts possession of, title to (subject to the conditions of the adoption contract) and responsibility for said dog adopted and agrees to release and discharge Rescue Me forever from liability for any injury or damages to any person or property caused by the adopted dog, and from any causes of action, claims, suits, including legal fees or demands whatsoever that may arise as a result of such injury or damages.
14.THE UNDERSIGNED understands that the parties hereby released and admit no liability of any kind by reason of the said adoption and that said adoption fee is made to terminate any further controversy respecting any and all claims for damages that said Adopter(s) has heretofore, asserted or might personally or through personal representatives hereafter assert because of said adoption.
15. By placing my signature below, I release Rescue Me-Purebred K9 Rescue, Inc. of any and all liability issues concerning this dog. From this day forward. I have been informed of any and all behavioral issues known by the rescue including, but not limited to, previous bite history. The rescue has also informed me of all known health issues concerning this dog, past and present, and from this day forward is released from any and all liability. Please initial: ______
UPON AFFIXING MY SIGNATURE TO THIS CONTRACT, I AGREE TO ALLOW RESCUE ME TO ENTER MY PROPERTY FOR THE PURPOSE OF REMOVING THIS DOG FROM MY CUSTODY IF I DO NOT COMPLY WITH THE ABOVE TERMS.
(This will be dated and signed on the date of adoption, not when completing the application.)
I have read and received a copy of and, hereby, agree to abide by ALL THE TERMS AND
CONDITIONS set for in this adoption application on the _____day of ______, 20___.
Signature of Adopter(s): ______
Signature of Rescue Me Representative: ______
Date: ______
PET Name & ID ______Adoption Fee: $ ______
Further Terms and Conditions:______
If Mailing Application Send to:Karen Trunfio
PO Box 758
Oneida, NY 13421
PLEASE BRING COLLAR AND LEASH WHEN PICKING UP DOG
Rev (3-12-14)