Save a Small Dog Rescue, Inc. Adoption App.

PO BOX 290462 PHELAN CA 92329 OFFICE (760) 269-4519 www.saveasmalldogrescue.org
FAX (760) 406-9329

A Non-Profit 501 (C) 3 Tax Exempt Organization Tax I.D. No. 27-1390045

ADOPTION APPLICATION/AGREEMENT
(Clicking SUBMIT constitutes a legal and binding contract)

* = REQUIRED

DATE:	ANIMAL'S NAME: *
TO BE ADOPTED: *	ALTERED?: YESNO APROX. AGE:
COLOR/MARKINGS: * BREED: *

ADOPTER'S NAME: *	Over 18*YESNO
SPOUSE'S NAME:	HOME PHONE: *
ADDRESS: * CITY: * ST.: * ZIP: *
ADOPTER CELL PHONE: SPOUSE CELL PHONE:
EMAIL: * TIME AT ADDRESS: * (X Years, X Months)

EMPLOYER: * WORK PHONE: *
SPOUSE'S EMPLOYER: SPOUSE'S WORK PHONE:
TIME AT JOB: * (X Years, X Months)

REFERENCE (NOT LIVING WITH YOU) NAME: * PHONE: *

ADDRESS: * CITY: * ST.: * ZIP: *

IF ADOPTING A DOG/PUPPY, WILL YOU DO OBEDIENCE TRAINING?: *YESNO

DO YOU LIVE IN A: * DO YOU OWN?: *YESNO

IF YOU RENT, LANDLORD'S NAME: LANDLORD'S PHONE:

HOW LONG HAVE YOU LOOKED FOR A PET?: *

ARE THERE ANY OBJECTIONS TO HAVING YOUR FACILITIES INSPECTED?: *YESNO

DOES ANYONE IN HOUSEHOLD HAVE ALLERGIES?: *

HOUSEHOLD ACTIVITY LEVEL: *

WHO WILL BE RESPONSIBLE FOR CARE AND FEEDING?: *

WHAT DO YOU PLAN ON FEEDING THIS PET?: *

PLEASE IDENTIFY YOUR LOCAL VETERINARIAN: *

IF BAD HABITS FORM, WHAT WILL YOU DO?: *

WHERE WILL THIS PET BE KEPT?: *

IS YOUR YARD(S) FENCED?: *YESNO TYPE AND HEIGHT:

DO YOU OWN A POOL?: *YESNO IS IT PET-SAFE-FENCED?: YESNO

WHAT ARRANGEMENTS WILL YOU MAKE WHEN TRAVELING?: *

LIST ANY PETS YOU OWN OR HAVE OWNED IN PAST FIVE YEARS: *

CAN YOU FINANCIALLY AFFORD THIS PET, HEALTHY OR SICK?: *YESNO

This form can not be submitted unless you have agreed to all of these conditions. Please read carefully Each item must be check in order

	I Agree
A. I agree to provide adequate love, food, water, shelter and medical care for this animal for his/her entire lifetime.

B. I agree to give this pet at least a one week adjustment period.

C. I agree that for the safety of this pet, it must be housed indoors, with the exception of exercise and potty breaks.

D. I have given serious consideration to the responsibilities of pet ownership and agree that he/she will be a member of our family for the duration of its life. This includes consulting a professional trainer and/or animal behaviorist.

E. If for any reason the adopter cannot keep the animal, the adopter MUST return this pet to SAVE A SMALL DOG RESCUE, INC. This pet cannot be given away.

F. If for any reason, the rescuer determines the adopter to become unfit, the animal will be returned to the rescuer immediately upon request. The adopter agrees to the rescue agency’s right to recover said animal, including procurement by police or animal control. The definition of “unfit” is solely the discretion of SAVE A SMALL DOG RESCUE, INC.

G. I agree that, as far as can be determined, this animal appears to be in good health. Should I notice any signs of illness within five (5) days of adoption, rescuer must be notified IMMEDIATELY! Failure to do so is a breach of this agreement. This section in no way obligates rescuer to any responsibility, refund, replacement or reimbursement. However, rescuer may be able to answer frequently asked questions and make referrals from a list of current providers.

H. I agree to keep a collar and or harness name tag on my pet at all times and to license him/her with the proper licensing authority in my area.

I. I agree that no warranties either expressed or implied are made with regards to breed, personality, exact age, appropriateness of a particular animal for the new owner or family, or extended good health.

J. I agree that my donation is not refundable but it is transferable. I understand that donations go to help other homeless pets and to assist SAVE A SMALL DOG RESCUE, INC. in fighting pet overpopulation.

K. I understand that the animals available for adoption through SAVE A SMALL DOG RESCUE, INC. are sometimes rescued from poor conditions. Even though all reasonable steps in proper care may have been taken, some cases of ear mites, upper respiratory, other parasites or conditions may occur from change in environment, diet, stress, etc. If any of these present themselves I will notify rescuer and see to proper treatment of my new pet.

L. If an adopted dog is returned to Save A Small Dog Rescue, Inc., through shelter, pound, micro-chip company, etc., there is a FIVE day window in which the owner has time to redeem the animal, (permitting health and grooming circumstances), in which at that time, the dog will be put back up for adoption.

M. By submitting this contract, the adopter agrees to all the above terms and conditions, to be responsible for the conduct of this animal and will hold the rescuer harmless, blameless and indemnified from any and all claims of liability. The adopter also agrees to pay a $30.00 returned check fee If, for any reason, the bank it is written on returns the item not paid. As of the date of this contract, adopter becomes owner/guardian of subject animal. By placing your initials here you acknowledge a receipt of a copy of the contract.

DRIVER LIC: * EXP: *
CHECK NO: CASH: