| 1. How did you hear about us? |
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| If "other" please explain: |
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| 2. Which one of these do you
live in? |
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| 3. Do you Own or Rent? |
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| 4. What is the apt. name, phone number, landlord’s
name and pet deposit fee of the complex? |
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| 5. Do you have the landlord’s permission
to own pets? |
Yes
No |
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| 6. If so what is the deposit required? |
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| 7. How long have you lived at your current
address? |
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| 8. Does anyone in your home have pet allergies? |
Yes
No |
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| 9. Have you ever been involved or are you
currently involved in breeding animals? |
Yes
No |
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| 10. Will this Cat be a surprise for anyone
in the house? |
Yes
No |
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| 11. If you move to an apartment or rental
that does not allow pets, what will you do? |
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| 12. How do you feel about Cats on the furniture? |
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| 13. Do any of you pets live mostly outdoors? |
Yes
No |
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| 14. Are your pets spayed or neutered? |
Yes
No |
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| 15. For which of the following reasons would
you consider giving up your cat? (check all that apply) |
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| 16. Have you ever given up a pet? If so please
explain the circumstances. |
Yes
No |
If so please explain...
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| 17. Please tell us who your current veterinarian
is as well as their address and phone number. |
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| 18. What are your pet’s names and species?
(So we can ask for records at your vet) |
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| 19. Has a cat on your premises ever died
of FIV, Feline-leukemia, or unknown causes? ...a Dog of Parvo or
Distemper? |
Yes
No |
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| 20. If you date or marry someone who does
not want you to keep your pet what will you do? |
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| 21. Have you looked at or applied for an
animal with another rescue group? If so did you adopt? Why or Why
not? |
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| 22. Do you object to a home visit from a
member of our organization? |
Yes
No |
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| 23. Where will your new cat stay during the
day? |
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| 24. Please list previous animal’s you
have owned and where they are now. |
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| 25. Do you think having ID on your cat at
all times is a good idea? If not then why? |
Yes
No |
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| 26. How much time are you willing to give
your new cat to adjust to its new home? |
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| 27. Where will the cat go when you leave
town? |
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| 28.Have you ever De-clawed a cat? |
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Yes
No |
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| 29.Are your current Cats De-clawed? |
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Yes
No |
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| 30. Do you intend to De-claw this cat? |
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Yes
No |
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| 31. Are your pets current on their vaccinations
and shots and can we call your vet to check? |
Yes
No |
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| 32. Please list the names and phone number
of two personal references: |
Reference1 |
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Reference2 |
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Please read the legal section carefully
and enter your name below. |
For and in consideration of The Dog House Rescue
and Adoption, Inc. (the "Dog House Rescue and Adoption")
allowing you to adopt one of its animals, the receipt and sufficiency
of which is hereby acknowledged, you agree as follows:
In signing this adoption agreement, you agree to provide a loving,
safe and caring home for your new companion. You acknowledge that
you have been fully informed to the best of your and The Dog House
Rescue and Adoption, Inc. staff's knowledge, about any history,
medical problems or treatments, and/or behavioral problems or
issues associated with your new companion. Upon full disclosure
of this information, you hereby exempt The Dog House Rescue and
Adoption, Inc. and its staff or representatives from all legal
damages which may be associated with such information.
You agree to allow a representative of The Dog House Rescue and
Adoption, Inc. to telephone and/or visit you and your new companion.
(Yes, you can even send us an occasional snapshot!) All Dog House
Dogs must be kept on monthly heartworm prevention and receive
routine veterinary care.
If you are adopting an animal too young to be spayed or neutered,
you agree to spay/neuter your companion BY THE TIME IT IS SIX
MONTHS OF AGE, and you agree to notify or have your vet notify
The Dog House Rescue and Adoption, Inc. when you have done so.
YOU AGREE NOT TO BREED THIS ANIMAL UNDER ANY CIRCUMSTANCES. The
Dog House Rescue and Adoption will not tolerate one of our rescues
being put out on chains or tie outs. A backyard is a must to take
home one of our dogs. We reserve the right to reclaim any animal
who is not in a fenced yard. The Dog House Rescue does not allow
the De-clawing of Cats. By signing this contract, you have agreed
not to de-claw the adopted cat. The Dog House Rescue and Adoption
reserves the right to reclaim any cat that has been de-clawed.
There are humane training techniques that an owner can use if
needed.
Further, in signing this form, you agree that if at any time in
the future, for any reason you can no longer keep and/or care
for your companion properly, you will contact The Dog House Rescue
and Adoption, Inc. or one of its representatives (Amelia) immediately. At that time, The Dog House Rescue and
Adoption, Inc. will take back your companion at no cost to you,
and provide shelter and care until a new home can be found. You
agree not to euthanize this animal for any reason without first
notifying The Dog House Rescue and Adoption, Inc. In the event
of accidental death of this animal, you agree to first notify
The Dog House Rescue and Adoption, Inc. or its representative(s)
immediately.
You understand that if this application contains any false or
misleading information, The Dog House Rescue and Adoption, Inc.
is entitled to reclaim your companion at any time. If in its discretion,
the Dog House Rescue and Adoption determines that an animal is
being abused, abandoned, or not otherwise properly cared for;
it reserves the right to reclaim the animal. You agree that the
Dog House Rescue and Adoption is not required to refund any adoption
fees or pay you any other money for an animal that it reclaims.
The Dog House Rescue and Adoption Inc. reserve the right to deny
an adoption application for any reason. The Dog House Rescue will
prosecute for any abuse or abandonment of one of our animals.
Pre-adoption veterinary requirements will be taken care of by
The Dog House Rescue and Adoption-Puppies/Kittens come with first/second
set of vaccines, continuation of veterinary care is the responsibility
of the adopter and is necessary for the continued health of your
new pet.
Although an animal is always welcome back if a complication arises
after an adoption all fees are non-refundable.
By entering your name below you are entering into a binding agreement
between yourself and The Dog House Rescue & Adoption Inc.
and are in agreement that all information on this form has been
filled out correctly and honestly to the best of your knowledge.
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Please choose only one of the answers below for
each statement.
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| I am aware that my new cat must be returned to The Dog House
Rescue & Adoption in the event I can no longer care for
it. |
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Yes, I agree
No, I do not agree |
| I am aware that the adoption fee for my cat is non-refundable
and goes to care for many of The Dog House Rescue & Adoption
animals in need. |
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Yes, I agree
No, I do not agree |
| I agree to let a representative of The Dog House Rescue
and Adoption visit my home prior to adoption |
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Yes, I agree
No, I do not agree |
| I understand that any attempt to falsify any information
on this application may be grounds for denial and/or relinquishment
of my animal back to The Dog House Rescue & Adoption,
Inc. |
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Yes, I agree
No, I do not agree |
| I understand that if I adopt a juvenile from The Dog House
Rescue and Adoption, Inc. I am still responsible for the remainder
of the vaccinations/shots. |
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Yes, I understand
No, I do not understand |
| I have read the legal section and I agree to its terms. |
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Yes, I agree
No, I do not agree |
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Name(required)
and Driver's License(optional on form
only) |
Name |
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Date |
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Driver's License# |
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