PET ADOPTION APPLICATION

I’m so happy you want to take me home to become part of your family!

But first, the pet counselors at Susie’s Hope Rescue would like to know more about you and the kind of life we’ll live together.

The questions on this application are not a test. They are simply to afford Susie’s Hope
Rescue confidence that you can and will take care of me. I will need to be fed regularly with nutritious meals. I will need to receive veterinary care from time to time. I will also need shelter, a place to run and have fun, and your undivided attention and unconditional love!

Requirements before you can adopt me...you must:

Be at least 18 years old

Make sure all the adults living in your household know about me and agree that I can live there

Have valid identification with your current address

Provide the landowners name and telephone number

Note: Susie’s Hope Rescue reserves the right to refuse any pet adoption.

Section I - Getting to Know You

First Name

Last Name

Address

Address Line 1

Address Line 2

City

Country

Select

State/Province

Select

Zip Code

Work Phone

Phone

Where do you live?

House
Condo
Townhome
Apartment
Dorm
Farm
Mobile Home

Do you

Own
Rent
Live with parents

Do you rent the lot?

Homeowner/Landlord/Landowner’s Name

First Name

Last Name

Address

Address Line 1

Address Line 2

City

Country

Select

State/Province

Select

Zip Code

Phone

Is the Homeowner/Landlord/Landowner aware you wish to adopt a pet and do you have pre-approval?

Have you ever adopted a pet from Susie's Hope Rescue or any other facility before?

Have you ever been refused adoption of a pet from any shelter?

If yes, why?

Section II - Tell Us About The New Family

How many adults live in your household?

How many children? Ages?

What will my role be in the family? Please check all that apply.

Please check all that apply.

Companion
Gift
For a child
Watchdog
Companion for another pet
Business Mascot

Who will be responsible for feeding me? How old is this individual?

Who will be responsible for training me?

Have you had pets within the past 5 years?

If yes, what kind?

Are there any pets in the home now? (include indoor and outdoor pets)?

Type/Breed

Where kept

Age

Spayed/Neutered

Vaccinated

Still own?

If no, why?

If you have pets now or had them in the past who is or was the veterinarian and the location?

If you have a pet now, when was it's last visit to a veterinarian?

Reason?

Does anyone in your household have allergies?

If yes, what kind?

If you move in the future, what will you do with your newly adopted pet and other pets?

Section III – The Pet’s Role in the Family

The purpose of this section is not to test you, but get you thinking about your responsibilities as a pet owner. After you fill out this section, you may have some questions about pet care. A pet counselor will be happy to answer them for you.

Did you know that in the first year, regular preventative medicine may cost $150 for an adult dog and $200 for a puppy?

Did you know that in the first year, pet food and pet supplies may cost $250?

Radio Description

About how many hours a day will the pet be alone in the home without human companionship?

How many days a week?

Where will it be kept during the day? And at night?

Day

Night

How many times per day do you plan to take the animal outside?

Who will be responsible for this?

Do you have a fenced yard?

If yes, describe the height and type of fencing material

If you don't have a fence now, do you plan to build one in the future?

A shelter is a structure that is insulated and has bedding inside. Shelter keeps the pet warm in winter and cool during the summer, and it affords the animal room to stand up, stretch out and lie down comfortably. Will shelter be provided?

For outdoor pets, what kind of shelter will be provided?

Do you plan to use a chain, rope or cable as the only means of keeping the pet confined?

Do you understand that state laws may require vaccinating, leashing and licensing dogs?

Have you ever been involved with an animal control department?

If yes, what were the circumstances?

Do you require the pet to be housebroken, or do you intend to train?

Do you plan to take the pet to obedience classes?

If so, what kind?

It may take your new pet up to two weeks to adjust to a new home, or longer if other pets are there. Are you willing to give your pet this much time to adjust?

What kind of identification do you plan to place on your pet?

Do you feel that female dogs should be spayed?

Do you feel that male dogs should be neutered?

Do you understand that pet overpopulation is a serious problem?

Section IV - A Lifetime Commitment

Are you willing, ready and able to provide a lifetime commitment of time, finances and emotion for this pet?

Section V - Adoption Agreement

Whereas the adopting person (as verified via signature in Section VI) agrees that he/she shall become the responsible owner of the pet, and release and hold harmless Susie’s Hope, its representatives and employees from any and all claims, risk, financial responsibilities related to or surrounding the animal’s behavior, actions, training and care. The new owner accepts full responsibility and risk in adopting and owning this pet.

Section VI – Certification Of Information

If for any reason if this animal does not work out in my home, I

will hereby return the animal to Susie's Hope, (TM). I will not give the animal, turn into a shelter, or harm in anyway. I realize my responsibility is to contact Susie's Hope Rescue with any problems immediately.

Adopter

By signing below, I certify that the above information is true and that I will recognize that any misrepresentation of facts may result in my losing the privilege of adopting or keep an adopted pet. I understand that Susie’s Hope Rescue has the right to deny my request to adopt an animal and I authorize investigation of all statements in this application. I understand that this application is the property of Susie’s Hope Rescue.

Signature

To accept this contract, type your name below

Date

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PET ADOPTION APPLICATION FORM

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