Dog House Rescue

Adoption Contract

Adopters Information
Full Name ___________________________________________________
Driver lic.#: ______________________ Age: ______________________________
Address:

____________________________________________________________

________________________________________________________________________
Phone Number: _____________________ (Home) _______________________ (Mobile)
Email Address: ___________________________________________________________

Would this be your first pet?

Yes

No

If not, give details of present or past pets:

What other animals do you currently have?

Have they been spayed or neutered?

Yes

No None

If you have other pets, will they adjust to a new pet entering the household? *

(Current Pet #1) Which of the mentioned family pets do you still have?
Breed:

Age:

Sex: Male/Female

Spayed/Neutered: Yes

Currently vaccinated: Yes

No

No (If not, Why?):

(Current Pet #2) Which of the mentioned family pets do you still have?
Breed:

Age:

Sex: Male/ Female

Spayed/Neutered: Yes

Currently vaccinated: Yes

No

No (If not, Why?):

(Current Pet #3) Which of the mentioned family pets do you still have:
Breed:

Age:

Sex: Male/ Female

Spayed/Neutered: Yes

Currently vaccinated: Yes

No

No (If not, Why?):

How many adults and children are in your family and what are their ages?
Does any member of your family have any allergies to animals?

Do you own or rent? Apartment or house

Is someone home during the day? Yes No

What type of enclosure are you planning to use for the pet and where will they live?

Do you have a veterinarian? Yes/No

Name, address and phone number of Veterinarian

Are you willing and able to pay the veterinary costs of caring for your new pet(s)? Yes/No

Are you willing to take the time to work with the pet on housebreaking or chewing, if such problems
arise? Yes/ No

How much time are you prepared to allow for your new pet(s) to adjust to your home?

In the absence of the primary caregiver, who will care for your pet(s)?

If you move will you take the pet with you? Yes/ No
Are you willing to care for the pet and take responsibility for it for the rest of its life? Yes/No

Have you given up your pets in the past? If so please give details: Yes/No

A home inspection may be required. Are you willing to allow the fosterer/rescuer to visit your home?
Yes/ No

What provisions will you make for the pet should you become unable to care for it?

Please provide us with two (2) references:

Name:

Phone:

Name:

Phone:

Adopters Agreement
I agree that the animal I am adopting will be neutered/spayed if not done prior to the adoption. This is
done free of charge if brought back to the rescues veterinary. The rescue needs to make the
appointment for the adopted animals neuter/spay.

I agree that the animal(s) is (are) being adopted for myself and will not be sold, adopted, or given to
another party. _________ (initial)

I agree that the animal(s) that is (are) adopted will not be used for commercial or breeding purposes and
I agree to sterilize the animal(s) if it (they) is (are) not sterilized at point of adoption. _________ (initial)

I agree that the animal will not be allowed outdoors without proper supervision. _________ (initial)

I agree to care for the animal in a humane manner and be a responsible animal guardian. This includes
supplying adequate food, water, shelter, attention, and medical care. _________ (initial)

I agree that if at any point I cannot keep the animal, I will return him/her to the original rescuer/adoptor
without requesting a fee. _________ (initial)

I understand and agree that the current fosterer makes no guarantees about the animal's temperament
and is not responsible for future damages or injuries caused by the animal. _________ (initial)

I give the current rescuer/fosterer permission to call my home at any reasonable time to assure that the
animal is being properly treated and cared for. _________ (initial)

I agree to keep the rescuer/fosterer informed of my current home address and phone number.
_________ (initial)

I agree that all statements I have made on this form are true. If it is found that any statements I have
made on this form are not true the adopted animal can be confiscated.

Adopter's Signature:

______________________________

Date:

______________________________