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Hootie’s Haven Animal Rescue Inc. 2500 Euharlee Rd SE, Rome, GA 30161 423-567-HOOT (4668) PUPPY ADOPTION APPLICATIONDate:_________Name:__________________________________________________________________Address:________________________________________________________________City:_____________________________________State:____________Zip:___________Driver’s license # and State (Required by Ga Dept of Agri.) ________________________Co- Applicant (spouse or significant other)_____________________________________Employer:_______________________________________________________________Home Phone:__________________ Work Phone:____________________ Cell Phone:_______________Email Address: ________________________________________________________________________1. Name of pet you are applying for: ______________________________________2. Description of pet you are applying for (or looking for): _________________________________________________________________________________________________________________________3. Where do you live? (Please check one) HOUSE APARTMENT TOWNHOUSE OTHER_______________I RENTI OWNWITH MY PARENTSLandlord’s name: ______________________________Phone:__________________4. Do you have a fenced yard?YESNOIf fenced, please describe the height and type:________________________________5. Please provide the following information about your household:Number of adults:________ Ages: __________________Number of children:________ Ages:_________________6. Is anyone in your family allergic to animals? YESNO CATS DOGS7. Would you be willing to allow us to visit your home before the adoption is completed? YES NO8. Who is/was/will be your veterinarian?Name:____________________________________________________________Address:__________________________________________________________Phone:___________________________________________________________9. Please provide a personal reference(s):Name:_________________________________Phone:_________________________10. What heartworm preventative do you plan to use:_________________________11. What flea preventative do you plan to use:_______________________________12. Please list your current pets and their breeds: ________________________Age:__________________________Age:_________, ________________________Age:__________________________Age:_________, ________________________Age:_______Are the current pets listed above up to date on all vaccinations:_________________Are all your dogs on heartworm prevention now:________________Page 213:Have you ever surrendered or re-homed a pet, and if so, why?_ _____________________________ Have you ever had to euthanize a pet? If so, why?________________________________________Have you ever lost a pet to an accident? If so, explain:_____________________________________14:How do you discipline your pets?______________________________________________________What potty training method do you plan to use?__________________________________________Do you plan to crate train your puppy?__________________________________________________NO FEET ON THE GROUND POLICYPuppies of this age do not have adult immunities yet. Their vaccinations will provide them immunities once they have completed all of them. Many harmful viruses and bacteria found in most public places can make a puppy very sick, or even cause its death. Until all vaccinations are given and this puppy is spayed/neutered and has had its rabies shot, this puppy may not be taken out in public to stores, dog parks, or for walks in any public areas. Its feet should not “touch the ground” anywhere but in your home, or in your yard. This policy is for the safety and health of your puppy!By signing below, I certify that the information I have given is true and that I recognize that any misrepresentation of the facts may result in my losing privilege of adopting a pet from Hootie’s Haven Animal Rescue Inc. I authorize investigation of all statements on this application.Signature:________________________________________________ Date:__________________Hootie’s Haven Animal Rescue Inc. has the right to refuse an adoption for ANY reason! Decisions by Hootie’s Haven Animal Rescue Inc. are in the best interest of the animal. All decisions by Hootie’s Haven Animal Rescue Inc. are final.PUPPY ADOPTION CONTRACTI agree to comply with the “No Feet on the Ground” policy until this puppy is fully vaccinated as described below. Initial:____________I understand Hootie’s Haven Animal Rescue Inc. is only financially responsible to ensure this puppy has had the recommended puppy vaccinations, been spayed/neutered, has been given a heartworm preventative starting at 12 weeks, and has been microchipped. Initial:________On (date)___________, this puppy has had the following vaccination(s) __________ on__________, and _______ on ________; and ___________ on ____________.By initialing below, I understand this puppy will need to be returned to Hootie’s Haven Animal Rescue Inc. on the following dates to receive the following: DA2PP #2 on ______________. Initial________ (cross out if not applicable)DA2PP #3 on ______________. Initial________ (cross out if not applicable)DA2PP #4 on ______________. Initial________Spay/Neuter & Rabies vaccination will be scheduled for the week of: ___________________ (at 12-14 weeks of age or when testicles have dropped). Initial_______.I understand Hootie’s Haven Animal Rescue Inc is only responsible for the medical services listed above. If I choose to seek additional veterinarian care, it will be at my own expense. Initial_______.This puppy will reside in my home as a pet. I will provide it with quality food, plenty of fresh water, indoor shelter, affection, annual physical examination, monthly heartworm prevention and yearly vaccination under the supervision of a licensed veterinarian. Initial:___________I understand that if at any time, Hootie’s Haven Animal Rescue Inc feels this puppy is in danger, or any of the conditions of this adoption are not met, the ownership of this puppy will immediately revert back to Hootie’s Haven. Initial ________.Pet ownership is a serious commitment that the entire household needs to consider and agree to before the animal is adopted. We want to ensure that each adoptive household is aware of and willing and able to accept the physical and financial responsibilities of pet ownership. I understand that this puppy/dog MUST be indoors and this dog WILL NOT live chained/penned outside unattended. I understand that I can return this puppy to Hootie’s Haven Animal Rescue Inc. within 7 days for a full refund. After that time, I understand I am no longer eligible for a refund. I agree that at any time and for any reason I no longer want or can no longer care for this puppy/dog, I will contact Hootie’s Haven Animal Rescue Inc. at 423-567-4668. I understand that I am not authorized to release this puppy/dog to any other party, whether related to me or not, and I agree that in any circumstance, if I can no longer keep this puppy/dog in its lifetime, the puppy/dog will be returned to Hootie’s Haven Animal Rescue Inc. I understand that although Hootie’s Haven Animal Rescue Inc. carefully screens animals for placement, it makes no guarantee relating to the health, behavior or actions of animal. I understand that I am adopting this animal at my own risk. I agree to allow Hootie’s Haven to use any photographs taken during the adoption process. I indemnify and hold harmless Hootie’s Haven Animal Rescue Inc. free from all liability arising out of any and all claims, demands, losses, damages, action, judgment of any and all kind and description which may occur to or be suffered by me, members of my household, or any third parties by reason of activities arising out of this agreement. By signing below I understand I am legally bound to this contract. Signature:________________________________________________ Date:__________________Name (Please print):_______________________________________________________________Hootie’s Haven Animal Rescue Inc. ___________________________________ Date:___________________Name (Please print):________________________________________________________________Amount Received:$_____________ Payment Method:_______________Received By:___________________________________________ ................
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