ADOPTION APPLICATION

Name:

__________________________________________________________________

Address: __________________________________________________________________
City: _________________________________________ State: __________ Zip:__________
Phone: ________________________________ Alt. Phone: __________________________
Email Address: ______________________________________________________________
Pet Information:
Adopted Pet Name: __________________________________________________________________
Breed/Description: ________________________________________________________
Estimated Age: ______________________

Male / Female

1.

Where do you live? (Single family home, apartment, etc.) ______________________

2.

Do you own or rent? _____ How long have you lived at this address? _____________

3.
If renting, what is the Landlord's name and phone number?
____________________________________________________________________________
4.

Does your landlord, HOA or insurance company have any breed restrictions? Yes / No / Not Sure

5.

Is there a fenced yard? ___ Height: ________ Privacy or chain link? _____________

6.

Number of adults in household? _____Number of children? ____Children's ages? ________

7.

Have you ever owned a dog/cat before? ______ If yes, where is the dog/cat now? _______

8.
Have you ever turned an animal into a shelter? ________ If yes, what were the circumstances?
_______________________________________________________________________________________________
9.

How long will the dog/cat be alone during the day? __ ______________________

10.

Where will the dog/cat be kept when alone? ______________________________

11.

What other pets are in the household? _______________________________________

12.

Are current animals spayed and/or neutered?__________________________________

13.
What is the name and phone number of your current veterinarian?
______________________________________________________________________________
14.

Where will this animal sleep? __ _____________________________________________

15.

When the pet is outside, what shelter is provided? ______________________________

16.
Are you willing to provide heartworm prevention, flea and tick control for this dog/cat along with any other
necessary medical expenses? _________________________________________
17.

Why do you want to adopt a dog or cat? ______________________________________

18.

Are you a student? _______ If yes, what will happen to this dog/cat at the end of the school year?

19.

Do you agree to return this dog or cat to F.U.R. if it does not work out for any reason? ____________

20.
What methods of discipline will you use for bad behavior (chewing, nipping, potty-training).
_______________________________________________________________________________________________
Are you willing to agree to a post-adoption follow-up in your home within 6 months? _________
Please provide 3 references:
Name

Phone

Relationship

_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
I certify that the above information is true and that false information may result in nullifying an adoption.
___________________________________
Signature
___________________________________
Name
___________________________________
Date

Note: A Home check is required prior to adoption for the safety of our rescued animals.
Please Complete and Return to: mike@FloridaUrgentRescue. com

ADOPTION AGREEMENT
I, ____________________________, residing at (address) ___________________________________________________________
_________________________________ hereby acknowledge adopting the above described animal from Florida Urgent Rescue, Inc.
Please Initial
_____ I understand that Florida Urgent Rescue (FUR) has no history on animals before they entered the rescue, and I understand
that FUR makes no representations about the breed, age, temperament or behavior of any animals I adopt. However, due
to the nature of rescue work and unpredictability of animals, and because a complete medical and/or behavioral history is
usually not available, FUR does not warrant and expressly disclaims the temperament or behavior of the Pet. Adopter
expressly acknowledges this disclaimer and agrees that Florida Urgent Rescue will not be liable for any acts of the Pet while
living with or in the ownership, custody, or possession of the Adopter, nor for any costs, expenses, or damages incurred as a
result of the Pet's conduct or behavior.
_____ Until the adoption is finalized, I understand that the pet will be on a sleepover and will be in foster status. During this
period, I agree to take the animal only to veterinary clinics approved by FUR, with appointments approved in advance. I
understand that I may take the animal to my own vet for an exam at my own expense, but I will not have any vaccinations
or medical procedures performed without prior written authorization from FUR. Duplicating vaccinations can cause serious
health problems for these animals.
_____ Introducing a new pet may create anxiety for existing pets or new pets, or both. I agree to keep my new pet(s) separated
from my existing pets for a minimum of 7 days, and to introduce them very slowly. If you wish to borrow a gate or a crate,
please let us know.
_____ I understand that my new pet may be anxious, disoriented or scared in a new environment, and I agree to keep my new
pet(s) separated from any children for a minimum of 5 days, and to introduce them very slow and only with adult
supervision. I agree not to leave my new pet unsupervised with children.
_____ I do not have any restrictions from my landlord, Homeowners Association or insurance company preventing me from
adopting an animal.
_____ I agree to provide this animal with proper care and humane treatment for the duration of his/her natural life, including:
proper nutrition, fresh water, indoor shelter, exercise, proper veterinary care, heartworm and flea prevention, affection,
training and other necessities to ensure my pet has a happy, comfortable life.
_____ I agree to this animal will live indoors as a member of the family, and I will not leave him/her outdoors unattended.
_____ I agree to ensure that all animals in my household are spayed/neutered, and I promise to never breed animals.
_____ I agree not to sell, trade, give away or otherwise give up this animal. If it does not work out for any reason and I am unable to
keep this animal, I agree to return my pet to FUR. I will never abandon my pet(s) or surrender them to a shelter.
_____ I agree to ensure my pet has ID tags on his/her collar at all times. I further agree to keep microchip registration up to date,
and to list Florida Urgent Rescue, Inc. as the secondary contact on my pets microchip.
_____ I agree to never cosmetically alter my pet, including cropping ears or docking the tail of a dog, or declawing a cat.

_____I certify that the above information is true and that false information may result in nullifying an adoption, and I understand
and agree that FUR reserves the right to refuse adoption to anyone at their sole discretion. No animal will be adopted to
anyone who misleads or fails to provide accurate information in the Adoption Application. If I violate the terms of this
adoption agreement, I understand and agree that Florida Urgent Rescue, Inc. will take the animal back and my adoption will
be null and void.
_____I hereby release and waive any claim against Florida Urgent Rescue, Inc. which I may have now or in the future for any
damages and/or injuries to person or property cause by said animal. Abuse, neglect or failure to comply with any provisions
in this agreement shall constitute a breach of contract and will result in the immediate removal of the animal from my
custody. Florida law and its applicable statutes shall apply to this contract, including its interpretation and enforcement.
_____Adopter acknowledges and accepts possession of the Pet at Adopter's own risk, which is voluntarily assumed, and hereby
expressly releases, waives, and forever discharges Florida Urgent Rescue, Inc. from any and all liability, claims, or causes of
action which Adopter or a third party may have now or in the future for any and all damages or injuries to any person or
property caused by the Pet. Adopter agrees to hold harmless, indemnify, and defend Florida Urgent Rescue, Inc. for any and
all claims, expenses, causes of action, or judgments arising out of Adopters adoption of the Pet from Florida Urgent Rescue,
Inc. and/or Adopters ownership or care of the Pet at any time thereafter.

Florida Urgent Rescue, Inc.

Adopter

________________________________________

________________________________________

Signature

Signature

________________________________________

________________________________________

Name

Name

________________________________________

________________________________________

Date

Phone Number

________________________________________
Email

________________________________________
Date

Admin Use Only

Drivers License Number: ___________________________

State Issued:

____________________________

Adoption fee paid: ___________________________

Date Finalized:

____________________________

Payment Type:

Amount:

____________________________

____________________________