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These are some questions I ask potential adopters to determine a) whether they could be good adopters and b) what dog would
be a good fit for them:
What kind of dog are you looking for? (size, age, personality...) Are you specifically looking for a puppy?
Do you have a fenced in yard? Is it secure (no holes underneath and tall enough that the dog can't jump over it)?
Where will the dog stay when you are not at home?
For how long during the day will the dog be left alone?
Are you prepared to deal with a dog that is not housetrained?
Will you be taking the dog to training classes?
Do you rent or own? (If you rent, I need to see a copy of your lease showing you are allowed to have this animal.)
Are you interested in adopting a "special needs" dog?
Are there children in the home? If so, what ages?
Are there other animals in the home? If so, what kinds?
Why are you interested in adopting a new dog?
Are you adopting the dog to be a companion for a child or another dog?
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ADOPTION APPLICATION
Adopter Name: _____________________________________________
Address: __________________________________________________
City: _______________________ State: ________ Zip: ________
Phone: ______________________
Email address: ____________________________________
Type of Dwelling:
Single Family Home/Villa/Townhouse/Condo/Mobile Home/Apartment
Do you: Own Rent Lease Co-Own
How long at this address: ________
Place of Employment: ____________________________________
Work Phone: ________________________________
Occupation: ___________________________
How long at this job: ___________________
Have you ever turned an animal in to a shelter? Yes No
Reason: __________________________________________________
Number of adults in household: _______ Children: _________
Ages of children under 18: ___________________________
Number of animals presently in household: ______________
Names & Types of animals: __________________________________________________________
Are your pets current on vaccines? _________ If no, why? ___________________________________________________________
___________________________________________________________
Primary Veterinarian: ___________________________________
Phone: ____________________
Are your pet's spayed/neutered? Yes No If no, why? ___________________________________________________________
Are your current pets microchipped? Yes No If no, why? ___________________________________________________________
Are your current pets on heartworm prevention? Yes No
Where do your current animals primarily reside?
Outside ____ Inside ____ Both ____
Do you have a fenced yard? _______________
Where will your new pet stay when you are not at home?
In house _____ Patio _____ Yard _____ Crate _____ Other _________________________________________________
Are you prepared to deal with a dog that is not housebroken? Yes No
Where did you get your last pet? _________________________________________________________
Why are you interested in adopting a new pet? __________________________________________________________
__________________________________________________________
INFORMATION DISCLOSURES
Please initial each paragraph
______ The animals we have for adoption are rescued animals. We do not have history or medical background from anytime
prior to their rescue. We cannot ensure that this animal has no prior conditions unless the veterinarian seeing it has been
able to detect them. It is always possible for an animal to be harboring an illness we are not aware of.
_______ The age on the animal's medical record is only an estimated age. There is no guarantee of the age.
_______ Though there is no record of this animal being vicious, aggressive, or biting a human or other animal, we cannot
guarantee that this animal will not do so in the future.
_______ Animal medical care can be very expensive. Please make certain you are prepared to take on the costs for yearly
medical maintenance as well as the potential costs for severe illness or accident care.
_______ There is a severe tick problem in XXXX. Even though we treat our animals, you may still find ticks and fleas.
Please bathe and check your animals as soon as you get home.
_______ We do not adopt an animal that is to be kept outside or used as a guard dog. Please be advised that we have
the right to do a home check on any adopted animals and if this pet is not properly taken care of, we will take the animal
back.
_______ If for any reason you cannot keep the animal you adopted, you CAN NOT give it to anyone else. You MUST return
the animal to Hands for Paws.
_______ You must keep this animal current on rabies vaccinations. _______________ is due for his/her next vaccination
on ___________________.
ADOPTION APPLICATION ADDENDUM - PROBATIONARY ADOPTION
I have adopted ____________________ from XXXXX on a probationary term. My home will be visited by a representative of
XXXXX within 10 days of the adoption date. If upon this visit, the representative feels my home is not an appropriate and
adequate place for ________________, the XXXXX representative has the right to take the dog and revoke the previously agreed
upon adoption agreement. My adoption payment of $95 will be returned to me in full.
ADOPTION APPLICATION ADDENDUM - STERILIZATION AGREEMENT
____________________ has not been spayed/neutered as of the date of adoption. By my signature below, I agree to take
him/her to a vet to be spayed. If by ______(date)________, this animal has not been spayed/neutered, XXXXX or its representative
has the right to take _________________ and revoke the previously agreed upon adoption agreement. My adoption payment of
$95 will not be returned to you. The $150 check will be destroyed upon proof of sterilization.
ADOPTION FEE RECEIPT
_____ I am paying a $95.00 fee for the adoption of ________________ from XXXXX. This fee is to subsidize a portion of
the costs paid for the medical health of the animal I am adopting.
_____ I am providing a check for $150 as a deposit for the sterilization of this animal. Once I provide proof of sterilization
to XXXXX, this check will be returned to me or destroyed.
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