Application

proverbs1210. Animal Rescue Adoption Application Contract Package

Thank you for your interest in wanting to adopt a dog from the proverbs1210 rescue center

Step One: Complete an adoption application either online or

Download,

fill, and return via e-mail at adopt@proverbs1210adoption.org

Step Two: Should proverbs1210 determine the application is a possible match with the dog requested, we will contact you to determine if the adoption can proceed. We will also contact your vet for a reference.

Step Three: If approved, payment will be required, and arrangements will be made for transporting the dog to you. (You pay the transport fee directly to the transport company.)

Dog Adoption form

First name

Second name

Street address

Apt/suite

City

State/ province

Postal zip code

Home/ Cell Phone #

Work phone

Please note any person (co-applicant) who will be sharing ownership of this pet.

Co-Applicants first name

Co-Applicants Last name

Co-Applicants Phone#

Are you at least 18 years of age?

Yes

Who are you adopting this pet for?

DOG INFORMATION

Please list the name of the dog(s) you're interested in adopting. If you're not interested in a particular dog, please just type "pre-approval" in the first choice box.

Have you ever owned a dog?

Yes

Why do you want to adopt a dog? (Check all that apply)

Guard Dog

Companionship

Outdoor Dog

Indoor Dog

Breeding

Watch Dog

Item 1Service/Therapy

Gift for Someone

Please tell us what you're looking for in a dog (example: size, age, breed, sex, temperament/personality, energy level, housebroken, good with cats/kids/dogs, etc.)

If you move in the future, what will you do with the dog you adopt?

During the day, where will this dog be kept? (Check all that apply)

Indoors

Outdoors

Crate

Garage

Kennel

Other

During the night, where will this dog be kept? (Check all that apply)

Indoors (House/Apt)

Indoors (Garage/Other)

Outdoors

Crate

Garage

Kennel

Other

This pet will be will be home alone how many hours (on average) each day?

Do you plan to take your dog to obedience training?

Yes

ABOUT YOU & YOUR HOUSEHOLD

Please indicate the type of you home live in?

House - Own

House - Rent

Mobile Home - Own

Mobile Home - Rent

Apartment - Rent

Condo - Rent

Live with Parents

If you rent, Landlords/Rental Agencies will be contacted to verify permission to own pets. This includes mobile home parks. Please provide the following:

Do you have a fenced yard?

Yes

If there are any children under the age of 18 in the household, please list their ages here:

Do you run a daycare in your home?

Yes

Are you a student?

Yes

Are all household members in agreement with this adoption?

Yes

Do any household members have pet-related allergies, and if so, to what?

Yes

CURRENT & PREVIOUS PETS

Have you ever adopted a pet from this or any other shelter/rescue?

Yes

Have you ever given a pet away or surrendered a pet to a shelter/rescue organisation?

Yes

Please list all animals in your care in the last 5 years (include roommate's or relative's pets currently residing in your home).

Please list the following for each pet: Name of Animal; Species (dog,cat,other); Breed; Age; Are they spayed/neutered? Still living with you? If not, please explain why.

PERSONAL REFERENCES

Please list two references who:

a) Know you well
b) Do NOT live with you
c) Did NOT accompany you to the shelter.

At least one reference must be unrelated to you.

ADOPTION DISCOUNTS

Please mark if any apply to you. We offer discounted adoption fees for senior citizens (ages 65 and over), as well as active military members and veterans. We may ask for proof of age/service.

Senior Citizen (65 yrs. and older)

Active Military Member or Veteran

N/A

Since many animals come from unknown backgrounds, Homeward Animal Shelter cannot be responsible for the health or behavioral problems and cannot guarantee personality or temperament. Therefore, I am prepared to provide any necessary medical care including regular vet care and annual vaccinations as well as any humane behavioural training required.

Check this box to indicate that you understand and agree to the above.

By typing my name below, I certify that the information I have given is true and that I recognize that any misrepresentation of the facts may result in my losing privilege of adopting a pet. I authorize investigation of all statements on this application. I also understand that Homeward Animal Shelter reserves the right to deny my adoption application for any reason if they feel it is not in the best interest of the animal(s).