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Adoption Form Samples

                                                                                          Adoption Questionnaire

                                                                                   for Potential New Dog Owners

 

AUSTRALIAN SHEPHERD6

 

Personal Information:

Name:_______________________________________________________

Home Phone: ______________________ Cell #: _____________________

Spouse’s Name (if applicable): ______________________________________

How many children in your home? __________ Ages: ____________________

Are there any others residing in your home? Please List:________________________

______________________________________________________________________

 

Do You Work Full Time___ Part Time____ Work from  Home__ Not  Working___ Retired____

Employer Name: ______________________________ Phone: ______________

Employer Address: _________________________________________________

City: ________________________________ State:__________Zip: __________

How long at this Job?: _____________________________________

 

Residential Information:

Home Address: ______________________________________________________

City: ______________________________ State: __________ Zip: ________

Will your New pet  live at this address? ____________

How long have you resided at this address? __________________________

If less than two years, what was your previous address? _________________

_______________________________________________________________

Do you Rent _____Own ___ Apartment? _______ House? _______

Condo? ________ Mobile Home? _________

What happens to the pet if you move?_______________________________________

______________________________________________________________________

If Renting, Are pets allowed?

What is your Landlord’s name? ________________________________

Landlord’s Phone Number: ________________________

Have you received permission from your landlord? ___________________

 

Other Adoption Information:

 

What do you think makes this particular pet a good choice for you? ________________

______________________________________________________________________

______________________________________________________________________

Have you had experience with this particular breed before? _________

Do you have a fence around your yard? Please describe: _______________________

_____________________________________________________________________

How will & how often will you exercise your pet? ___________________________________________

____________________________________________________________________

How many hours are you away from home during the average work day? _________

Where will your pet be kept during that time?__________________________________

Where will your pet be sleeping, not alone, during the night? ______________________________

What other kind of other pets do you have in the home? Please list:

______________________________________________________________________

______________________________________________________________________

Are all your pets current on their vaccinations? _____________

Your Veterinarian’s Name: _______________________________________________

City: ________________________ Phone Number: ___________________________

Does anyone in the household have allergies? ________________________________

Does anyone in the household have Asthma? _________________________________

Have you or anyone in your household ever been convicted of animal cruelty, neglect,

or abandonment? ___________

Have you ever had to give up a pet before ? Please explain: _________________________

_____________________________________________________________________

Are there any other comments you would like to make? ________________________

_____________________________________________________________________

______________________________________________________________________

I, (name)__________________________________ certify that all information provided on this form is true. I give permission to Rescuer to verify information as needed. I understand that a home check may be mandatory prior to adopting a pet, also. Any false statement will terminate potential adoption.

Signature: ___________________________________ Date: __________________

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Adoption Contract

 

Rescuer’s Information:

Name:____________________________________Spouse/Other_________________

Address:_______________________________________________________________

City:__________________________State:_____________Zip Code:

Home Phone:___________________ Cell Phone: ________________________

Email Address: ____________________________

 

Adopter’s Information:

Name:____________________________________Spouse/Other_________________

Address:_______________________________________________________________

City:__________________________State:_____________Zip Code:

Home Phone:___________________ Cell Phone: ________________________

Email Address: ____________________________

Driver’s License: _______________________ License Plate: _______________

This contract is a written agreement to transfer ownership of adoptive pet from the

Rescuer (name)___________________________________________________

to the Adopting Parent(s) (name)_______________________________________

on this date: _________________________________.

 

Adoptive Pet’s Information:

Name:____________________________________Cat/Dog/Other:________________

Male/Female: _________ Date of Birth or assumed age: ________________

Color:____________________ Description/Breed:______________________________

______________________________________________________________________

Shelter Rescued From: ___________________________Date:___________________

Shelter Fees: $_______________________ Vet Fees: $___________________

Altered Date:___________________ MicroChip #: ________________________

Adoption Fee:

Rescuer and Adopting Parents have agreed upon the sum of $ _______________ donation to Rescuer for help with expenses incurred by saving this pet from the shelter and vet bills.

 

Adoptive Parent(s) Agreement

I, (adoptive parent(s) name):___________________________________________

agree to provide care from this day forward to my new pet. This includes adequate food, water, exercise, shelter, veterinary care, and lots of love. The pet will be kept in the house and will not be tethered outside.

I agree never to sell, trade, or surrender the pet to any agency without giving prior notice to: (Rescuer’s name):___________________________________________.

I agree that Rescuer will have first option of reclaiming the pet.

I agree that the adoption fee is non-refundable and there is no reimbursement if the adoption does not work out unless agreed upon by Rescuer in terms listed below:

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

I agree that all expenses incurred after I take possession of pet will be my sole responsibility and Rescuer is released of any and all liabilities whether financially or other.

I hereby understand that the Rescuer has obtained this animal from the shelter stated above and may have no prior information of age, breed, health issues, training, registration, or other. Any information shared by Rescuer is of own experience with the pet and Rescuer makes no warranties of any kind concerning pet.

Adoptive Parent(s) signature(s):_____________________________________

______________________________________

Date: _______________

Rescuer’s signature(s): _______________________________________

_________________________________________

Date: _______________