SAMPLE ADOPTION/FOSTER APPLICATION & CONTRACT
NEW BEGINNINGS PET RESCUE
1529 W. 16th St.
Davenport IA 52804
Our purpose is to place an animal in a responsible home where it will receive veterinary care when needed, and where it will be controlled so as to not become a free roaming animal, or add to the surplus of animals already in the community. All homes must be indoors.
In order to be considered for an adoption today you must be 18 years of age, have knowledge and consent of all adults living in your household, have a valid Id with current address, your landlord’s name and phone number.
Understand that your NEW BEGINNINGS PET RESCUE adoption application must be approved and we reserve the right to refuse any adoption.
Cat/Dog Male/Female Animal’s NAME ______________________
Adopter’s Name Birthdate Address ____________________________
City State Zip Code Date ___________________
Home Phone # Work Phone # _______________ E-mail ___________________________
Employer City/State _______________________ How long? ________________
Do you live in a: House _____ Apartment _____ Condo _____ Dorm _____ With Parents ______
I RENT ________ I OWN ________ MOBILE HOME ________ FARM ________
Landlord’s Name Address _______________________________________
City State Zip Code Phone # _______________________
Number of Adults in household ____ Number of children in household______ Ages of Children ________
Have you ever adopted an animal from a shelter before? Yes ____No_____
Have you ever been refused adoption of a pet from a shelter Yes ____ No ____
Which member of your family will be in charge of taking care of the new pet? _______________________
Why are you adopting a pet today? Check all that apply: gift ___, companion for another pet ____,
for a child ____, companion ____, mouser _____.
Please describe in your own words why you would like to adopt this pet?
What kind of pets do you own now or have owned in the past 5 years:
TYPE/BREED KEPT WHERE? AGE ALTERED SEX STILL OWN IF NO WHY?
If you have pets now or in the past, who is (was) your veterinarian?
1. Name ________ _____________________________ Phone # ________________________________
2. What immunizations has your pet had within the last year? __________________________________
3. When was your current pet’s last visit to a vet? _______________Reason_______________________
4. Do any family members have allergies to animals? __________No___________________
5. If you move in the future what will you do with your pet? ____________________________________
6. Do you have a fenced yard? Y___ N___ If not, do you plan to fence? Y ___ N ___
7. Do you plan on using a chain or rope to tether the dog? Y ___ N ___
8. Do you understand that state laws require vaccinating and leashing dogs? Y ___ N ___
9. Do you plan to take your dog to training classes? Y _X__ N ___ If yes, what kind? ______________
10. Where will your dog be kept during the day? At night _________________________
11. What type of identification will be placed on your dog? _____________________________________
12. What arrangements will you make when you are out of town?_________________________________
In adopting this pet, the owner agrees to:)
1. Accept and keep the dog / cat as a companion.
2. Provide humane care – giving pet proper food, water, shelter, exercise, and attention.
3. See that a veterinarian gives this pet regular preventative care and immediate medical attention when it becomes ill or injured.
4. Not permit the animal to be used for vivisection or experimentation.
5. Comply with all state, county, and municipal laws pertaining to animals.
6. Indemnifies and holds harmless Northeast Iowa Pet Rescue for any damages which the pet may do to any person or property.
7. Return the animal to Northeast Iowa Pet Rescue if it can no longer receive adequate care (food, shelter, affection and attention).
8. Understand that adopting an animal is a 12-20 year commitment.
9. If not already done, spay or neuter the pet within 3 months if not already done.
10. Acknowledge that this animal remains the property of New Beginnings Pet Rescue until such time as it is altered, and waives all rights to such animal until such time as he/she is altered. By signing below, I acknowledge that I understand this animal may be removed from my care by New Beginnings Pet Rescue, or it’s agents, if I fail to follow through with alteration of said animal.
Should a medical problem develop within seven (7) days, the animal may be returned with a veterinarian’s statement regarding the problem. Or if the animal is not compatible in the home within the first seven- (7) days, the adopter may request their adoption fees be refunded.
NEW BEGINNINGS PET RESCUE reserves the right to REFUSE adoption of an animal to a home that does not meet the above standards. This includes the right to follow up animal adoptions and remove the animal if:
1. The animal is not receiving adequate care.
2. The animal is being abused.
3. The dog is penned outside day and night or housed in a garage or out building all the time with no human interactions.
4. The cat is allowed to roam outside unsupervised by its owner.
5. The animal is not medically altered during the time limit to do so.
ALL SHOTS, MEDICINE, VERTERINARY EXPENSE, BOARDING, AND OTHER LIABILITY OBTAINED AFTER ADOPTION ARE THE SOLE RESPONSIBILITY OF THE OWNER. Depending on the age of the dog/puppy, New Beginnings Pet Rescue will have, at the minimum, the first set of puppy shots given by our veterinarian. If the dog is an adult, all shots and spay/neuter will have been done prior to adoption.
If the following statement is checked, it applies to the animal I am adopting:
_______ I have been fully informed that the animal has previously bitten someone and assume any and all risk for the animal and indemnify NEW BEGINNINGS PET RESCUE and hold it harmless for any further actions of this animal.
By signing below I certify that I have read all the above information and have provided all true information. I recognize that any misrepresentation of facts may result in my losing the privilege of adopting or keeping an adopted pet. I understand that New Beginnings Pet 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 New Beginnings Pet Rescue.
Adopting Party Signature Signature – New Beginnings Pet Rescue
Applicant interviewed Date _____________ by ___________________________
Adoption approval Yes _______ No ________ If no, why? ____________________________________
Landlord’s approval Yes _______ No ________ If no, why? ________________________________________________________________________________________________________________________________________________________________
New Beginnings Pet Rescue
If for ANY reason I cannot keep this pet, I will call New Beginnings Pet Rescue and return the animal to them.
Bunny/Cat/Dog Male/Female Animal’s NAME ______________________
$__________________________Other Adoption Fee: Cash/PayPal/Money Order
By signing below, I have entered into a binding agreement with New Beginnings Pet Rescue to adopt the above animal and to follow all the above rules and stipulations. If applicable, I will show proof within 90 days that the pet has been altered.
_____________________________Date ________ __________________________________
Adopting Party Signature Signature – Northeast Iowa Pet Rescue
For Office Use Only:
Intake Date: ___________________
Vaccination Date and Type: ________________
Adoption Date: ___________________________
Adopting Party: __________________________
Rabies ID No. ____________________________
Date Altered: _____________________________