Proverbs 12:10 - Petfinder



|Proverbs 12:10 Animal Rescue | | |

| |Helping “HIS” Helpless | |

| | | |

| |PO Box 279, Burns, TN 37029 | |

| |Tel: (615) 446-8373 | |

| |proverbs1210rescue@ | |

NO REFUNDS APPLICATION CONTRACT DATE:     ________

Please fill out as much of the information as you can. This information will be used to evaluate your situation and help us assist you in adopting the right pet. None of the information will be sold or given to any other organization without your explicit consent. Fields marked with ** are required fields and must be completed in order for your application to be submitted for review.

|Pet’s name |      |M F |Spayed/Neutered |Yes No |

|Breed/mix |      |Date to be spayed/neutered |      |

|Color/markings |      | | |

|**Name |      |**e-mail |      |

|**Address |      | | |

|**City |      |**State |      |**Zip |      |

|**Home Phone |(     )     -      |**Work Phone |(     )     -      |

| Which phone is best to contact you? |cell home work |**Cell Phone |(     )     -      |

| What is the best time of day to call? |      |Driver’s License |State:       #      |

| | | | |

|Do you own or rent your home? | | |

| |If you rent, are pets permitted in your lease? | Yes No | |

| |Landlord’s Name: |      |Landlord’s Tel No |(     )     -      |

|Type of home? | House Apartment Condo Mobile Home Duplex Other       |

|How long have you lived at this address? |      | |

| | | |

|Do you plan to move in the near future? | Yes No | | |

| |What would you do with this pet if you had to move in the near future? | |

| |      |

|Are there children in the house? | Yes No |If yes, what are their ages? |      |

|Is anyone in the household allergic to animals or suffer from asthma | Yes No | |

| |If yes, how severe is the condition? |      |

|Number of adults in the household? |      |

| |Have all agreed to the adoption? | Yes No |

| |Names of other adults |                  |

|Personal references: | |

|Name |Phone Number |

|1.      |(     )     -      |

|2.      |(     )     -      |

Proverbs 12:10 reserves the right to refuse adoption to anyone. No animal will be adopted to prospective owners who mislead or fail to provide accurate information on the adoption application. If the conditions of this contract are not met, the adopter will pay all court costs and fees. If the animal is out of state, the adopter will return said animal back to Proverbs 12:10 at the adopter’s expense.

By signing below, I certify that the information I have given is true and any misrepresentation of the facts may result in my losing the privilege of adopting a pet. I authorize investigation of all statements in this application. I understand that this application is the property of Proverbs 12:10 Animal Rescue.

|** Signature: |      |** Date |      |

Proverbs 12:10 Adoption Application – page 2

The following information is requested so that your adoption counselor can assist you in the selection of a new pet. The animal’s welfare is our foremost consideration. This consultation is designed to help us determine if the adoption is in the animal’s best interest, and to assist you in finding an animal most compatible with your lifestyle. The animals available for adoption came here from a variety of sources and backgrounds and in some cases their past history is unknown.

Our adoption fee includes the first series of vaccinations (for puppies this includes a series of (3) three shots) including rabies and de-worming; heartworm testing and Feline leukemia/aids testing are done as applicable. Adoptive owners are required to keep the pets current on all vaccinations following adoption.

What kind of pet are you here to adopt (check all that apply)

Dog Puppy Cat Kitten Other (specify)     

|Why do you want this pet?       |

|Is this your first experience with this type of pet? | Yes No |

|Do you realize that you will probably have to house-train your new pet? | Yes No |

|List all the animals that you currently own or have owned in the past 5 yrs: type, age, spayed/neutered, inside/outside and where they are now. |

|Name |

|Type |

|Age |

|Spayed/Neutered |

|Inside |

|Outside |

|Where is the pet now? |

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|1.       |

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|2.       |

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|Yes No |

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|3.       |

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|Yes No |

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|4.       |

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|Yes No |

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|5.       |

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|Yes No |

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|Are current pets up to date on vaccinations? |

|Yes No |

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|Are current dogs on heartworm preventative? |

|Yes No |

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|If your pet becomes ill can you afford the vet bill to heal them (possible $100-$500) |

|Yes No |

| |

|Vet’s Name |      |Vet’s Phone |(     )     -      |

|Past Vet’s Name |      |Past Vet’s Phone |(     )     -      |

| | |

| | |

|Who will have responsibility for caring for the pet? |      |

|Are you prepared to allow a minimum of 2 weeks for the pet to adjust to your home? | Yes No |

|Are you committed to providing a responsible home for the pet, up to 15 years or more? | Yes No |

|Where will this pet stay during the day? |      |

|Where will this pet stay during the night? |      |

|How many hours a day will the pet be left alone? |      |

|Where will the pet be kept when you are away from home? |      |

Dog/ Puppy adoptions only:

|How will you train your dog/puppy? |      |

|How often will you take your dog/puppy outside to pee or poop? |      |

|Would you like information on how to house-train your new dog/puppy? | Yes No |

|Are you familiar with the leash and licensing laws in your community? | Yes No |

|Are you familiar with heartworm disease? | Yes No |

|Is your yard fenced? | Yes No |Is there a lock on the gate? | Yes No |

|How will you keep your dog/puppy confined to your property (check all that apply)? |

| House Kennel Fenced Yard Chain Garage Patio Leash Runner Electronic Fence |

|What will you do if your dog/puppy chews or scratches furniture of shows other destructive behavior? |

|      |

Cat/Kitten adoptions only: page 3

|Do you want the cat/kitten for a: (check all that apply) | |

| House pet Mouser Companion Gift Company for other pet |

|Other (specify)       |

|Will the cat/kitten be allowed outdoors? | Yes No |

|Do you plan to have your cat/kitten declawed | Yes No |

|What will you do if you cat/kitten claws furniture or shows other destructive behavior? |

|      |

Please read carefully:

As an adoptive parent of the Proverbs 12:10 Animal Pet Rescue, I understand and agree to do the following:

 

1. I understand that spaying/neutering my pet is a condition of this adoption and that I am responsible for the cost of this procedure. I agree that I will have the pet spayed/neutered no more than 30 days after the pet reaches the age of (6) six months.

2. A deposit (preferably in the form of a check which will be held un-cashed) equal to the adoption fee will be provided to Proverbs 12:10. Once documentation is provided the deposit will be returned to me. I understand that if I fail to provide this documentation before the pet reaches the age of (6) six months, the deposit check will be cashed and this adoption is null and void and the pet will be returned to Proverbs 12:10. If Proverbs can arrange for the spay/neuter of my pet, I agree to make all scheduled appointments made on my behalf and will provide documentation to this effect.

NOTE:  While you may have the spaying/neutering done by the veterinarian of your choice, Nashville Humane Society is available to Davidson County residents to spay/neuter pets at a reasonable cost - another option to consider is Value Vets.

3. I agree that if for any reason this adoption does not work, I will contact Proverbs 12:10 and make arrangements to return my pet to Proverbs 12:10 AND ONLY to Proverbs 12:10. I understand I am responsible for any costs associated with returning the pet to Proverbs 12:10 and that there are NO REFUNDS of adoption fees. This ensures they will find a permanent home with suitable accommodations, responsible owners, and that they will never be euthanized. I agree that I will have the pet spayed/neutered as arranged by Proverbs 12:10 no more than 30 days after the pet reaches the age of (6) six months.

4. I agree to provide the proper food, water, adequate shelter and kind treatment at all times.

5. I agree to take my adopted pet to the vet for annual vaccinations, checkups, and will keep him or her on heartworm preventative. Should my pet become ill or get injured, I will immediately take him or her to the vet.

6. I agree I will not use the pet for hunting purposes.

7. My pet will be in a fenced yard, on a leash, or on a large acreage tract. He/she will never be tied. This pet will preferably be inside, but will ALWAYS be inside if there is excessive heat or cold (i.e.: above 85 degrees or below 32 degrees) or during stormy weather.

8. I agree that a Proverbs 12:10 representative can make an unscheduled visit after adoption to ensure the pet’s well being. If it is deemed the pet is not being well cared for, Proverbs 12:10 may enter my property and Proverbs 12:10 may take possession of the animal.

9. I agree that Proverbs 12:10 cannot guarantee the health, temperament or training of the pet listed above and agree to release Proverbs 12:10 from all liability once the animal is in my possession.

10. It is my honest intent to give this pet a “forever” home.

11. I have read these statements and understand the rights and obligations involved.

|Signature of Adopter: |      |Date |      |

My initials here indicate my understanding that a typed signature above is legal and binding.      

|Signature of Rescuer: |      |Date |      |

(adoptee copy) page 4

Please read carefully:

As an adoptive parent of the Proverbs 12:10 Animal Pet Rescue, I understand and agree to do the following:

 

12. I understand that spaying/neutering my pet is a condition of this adoption and that I am responsible for the cost of this procedure. I agree that I will have the pet spayed/neutered no more than 30 days after the pet reaches the age of (6) six months.

13. A deposit (preferably in the form of a check which will be held un-cashed) equal to the adoption fee will be provided to Proverbs 12:10. Once documentation is provided the deposit will be returned to me. I understand that if I fail to provide this documentation before the pet reaches the age of (6) six months, the deposit check will be cashed and this adoption is null and void and the pet will be returned to Proverbs 12:10. If Proverbs can arrange for the spay/neuter of my pet, I agree to make all scheduled appointments made on my behalf and will provide documentation to this effect.

NOTE:  While you may have the spaying/neutering done by the veterinarian of your choice, Nashville Humane Society is available to Davidson County residents to spay/neuter pets at a reasonable cost - another option to consider is Value Vets.

14. I agree that if for any reason this adoption does not work, I will contact Proverbs 12:10 and make arrangements to return my pet to Proverbs 12:10 AND ONLY to Proverbs 12:10. I understand I am responsible for any costs associated with returning the pet to Proverbs 12:10 and that there are NO REFUNDS of adoption fees. This ensures they will find a permanent home with suitable accommodations, responsible owners, and that they will never be euthanized. I agree that I will have the pet spayed/neutered as arranged by Proverbs 12:10 no more than 30 days after the pet reaches the age of (6) six months.

15. I agree to provide the proper food, water, adequate shelter and kind treatment at all times.

16. I agree to take my adopted pet to the vet for annual vaccinations, checkups, and will keep him or her on heartworm preventative. Should my pet become ill or get injured, I will immediately take him or her to the vet.

17. I agree I will not use the pet for hunting purposes.

18. My pet will be in a fenced yard, on a leash, or on a large acreage tract. He/she will never be tied. This pet will preferably be inside, but will ALWAYS be inside if there is excessive heat or cold (i.e.: above 85 degrees or below 32 degrees) or during stormy weather.

19. I agree that a Proverbs 12:10 representative can make an unscheduled visit after adoption to ensure the pet’s well being. If it is deemed the pet is not being well cared for, Proverbs 12:10 may enter my property and Proverbs 12:10 may take possession of the animal.

20. I agree that Proverbs 12:10 cannot guarantee the health, temperament or training of the pet listed above and agree to release Proverbs 12:10 from all liability once the animal is in my possession.

21. It is my honest intent to give this pet a “forever” home.

22. I have read these statements and understand the rights and obligations involved.

|Signature of Adopter: |      |Date |      |

My initials here indicate my understanding that a typed signature above is legal and binding.      

|Signature of Rescuer: |      |Date |      |

-5-

TAX INFORMATION FOR DONATIONS

MADE TO PROVERBS 12:10

ANIMAL RESCUE & ADOPTION, INC.

Thank you for adopting your new animal companion from Proverbs 12:10 Animal Rescue & Adoption, Inc. (Proverbs).

Proverbs is a 501(c)(3) charitable organization under the federal tax code. As a result, contributions made to Proverbs are tax deductible. While the fee that you paid for your adoption is not deductible, as it represents payment for the animal provided as well as its shots and vaccinations, we welcome and encourage you to consider donating to Proverbs now or in the future.

Your donation will help us to continue our mission to rescue animals that are in abusive situations or are scheduled to be euthanized throughout the middle Tennessee area.

Donations can always be made to: Lavonne Redferrin, Proverbs 12:10,

Post Office Box 279, Burns, TN 37029.

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