Room For One More Pet Rescue, Inc.

Forever Home . . . One Pet At A Time!!

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ADOPTION APPLICATION
Please complete the application completely.  Use N/A if a question does not apply to you.  All information obtained will be only for the purpose of determining your suitability for a certain pet and will be kept strictly confidential.  Also, please read the Adoption Contract at the bottom of this page.  You will be required to sign it when your adoption takes place.
Which Pet Interests You:
Your Name:
Address Line 1
Address Line 2
City
State
Zip Code
Daytime Phone() -
Evening Phone() -
E-mail Address
Employer:
Job Title:
Work Phone:() -
Name of Your Vet:
Vet's Phone Number:() -
Own/Rent?
How Long?
If You Rent, Are Pets Allowed:
Landlord's Name:
Landlord's Phone #:() -
How Many Adults Reside:
How Many Children/Ages:
How Often Do Grandchildren Visit:
Is Anyone Home During The Day:
May We Visit Your Home:
Are You Financially Prepared for a Pet:
Have You Ever Brought An Animal to a Shelter:
Reason:
What Pets Do You Currently Own:
What Breed/Sex:
Is He/She Up To Date on All Shots:
Is He/She Neutered/Spayed:
What Pets Have You Previously Owned:
How Long Did You Have Them:
What Happened To Them:
Is Anyone In Your Household Allergic to Animals:
Where Will New Pet Live:
Where Will New Pet Sleep:
Where Will Your New Pet Be When No One Is Home:
Where Will Your New Pet Be When You Are Home:
Have You Previously Crate Trained:
Any Objection To A Crate:
Do You Have a Secure Fenced Yard:
How Many Hours Will Pet Be Alone:
What Kind of Temperament Are You Looking For:
Do You Have Age Preference:
Do You Have Sex Preference:
Would You Consider Special Needs Pet:
Will You Commit to This Pet For The Rest of His/Her Life:
Why Do You Want to Adopt:
Additional Comments:
Additional Comments 2:
Additional Comments 3:
Signature:
Date:

I affirm that all information above is true. I realize that this is a lifetime commitment and will endeavor to give this pet a happy, healthy home. IF THERE ARE PROBLEMS WITH THIS PET, I WILL IMMEDIATELY CONTACT MY PET'S FOSTERMOTHER FOR ASSISTANCE, OR IF I MUST GIVE IT UP, I WILL RETURN IT TO THE FOSTER HOME. WHILE CONSIDERING THIS ADOPTION, I WILL HOLD THE FOSTERMOTHER AND THE FOSTER HOME HARMLESS FOR ANY PHYSICAL, MEDICAL OR PERSONAL PROPERTY DAMAGE.

ROOM FOR ONE MORE ADOPTION CONTRACT

This contract is made between:

_____________________________________________ (Adopter) and Room For One More (Rescuer).

ROOM FOR ONE MORE PET RESCUE AGREES TO DO THE FOLLOWING:

1. Give the ADOPTER title to, possession and control of the dog as described:

Name of Pet: _____________________________________________________

Sex: _____ Male _____ Female Microchip #: ___________________________

Breed: ______________________________________Approximate Age: _____

Color: ________________________ Heartworm: + positive - negative

For so long as the ADOPTER complies with the terms of this contract.

2. Provide ADOPTER with any and all veterinary records available for dog. It is strongly recommended that ADOPTER immediately sign up for 2 free months of Sheltercare Pet Insurance provided by Petfinder.com. All dogs are spayed or neutered prior to adoption or an appointment has been scheduled if the dog is not yet old enough to be spayed or neutered.

3. RESCUER acknowledges receipt from ADOPTER of a donation as noted below to aid with reimbursement of veterinary and/or any other expenses incurred to consider dog for adoption. If requested, RESCUER will refund any adoption donation made if the dog covered under this contract is returned within 7 calendar days from the date of this contract. The ADOPTER shall forfeit any donation made if requested after seven days.

IN RETURN, THE ADOPTER AGREES TO THE FOLLOWING:

4. If the dog proves to be in poor health such that major treatment is necessary, the ADOPTER may return the dog within 7 days of the date of this contract. ADOPTER must provide a written confirmation to RESCUER from a veterinarian of the dog’s health and the necessity for major treatment.

5. Keep the dog as a pet and companion and not to abandon, trade, give away, or sell it, nor is the dog to be used or sold for commercial use or research purposes. If the ADOPTER no longer desires or is unable to keep the dog within the terms of this contract, the dog must be returned to RESCUER. It is NEVER to be turned over to an animal shelter or passed to another owner.

6. Provide adequate, high-quality food, water, shelter, exercise, and medical care at all times and care for the dog in a devoted and humane manner for the remainder of its natural life.

7. Have the dog examined by a licensed veterinarian within one month of adoption and at least once a year thereafter, maintain appropriate vaccinations and other preventive health and dental care, including but not limited to year-round heartworm and flea prevention, and provide copies of the dog’s care records to RESCUER upon request.

8. Provide a humane collar or harness for the dog to wear at all times and to keep on this collar, at minimum, the rabies tag.

9. During the dog’s lifetime RESCUER may visit the premises where the dog is kept and reclaim the dog if, in the judgment of the RESCUER, the dog is not being adequately cared for or ADOPTER has not complied with any provision of this contract.

10. ADOPTER agrees to pay all costs necessary to enforce this agreement including reasonable attorneys’ fees, costs of litigation, dog recovery fees, and all medical bills to restore the dog’s health back to adoptable status.

11. The ADOPTER authorizes any animal care or control agency to release the dog to a RESCUER representative, hereby designated as Agent for the ADOPTER, if the dog is found running at large or is brought into a sheltering facility for any reason.

12. ADOPTER acknowledges that the dog is adopted “as is” and that no implied or expressed warranties have been made by RESCUER in reference to the health, training and/or temperament of the dog. RESCUER shall not be held responsible for any veterinary expenses after adoption of the dog or held liable for any misrepresentations unknown to this RESCUER.

13. ADOPTER understands that should the dog cause personal injury or property damage after adoption, the RESCUER shall in no way be liable in whole or part for that damage and hereby assumes and agrees to hold RESCUER harmless from any and all liability for the dog, or any injury or damage that may be caused by it. ADOPTER hereby waives all claims, losses, or damages which may arise after the adoption of this dog, caused by any act of omission by RESCUER which results in personal injury or property damage to any person by this dog, and the ADOPTER agrees not to bring any legal action seeking any remedy against RESCUER in connection with this agreement or in connection with personal injuries or property damage claimed to result from any act or omission by RESCUER whether by ADOPTER or any third party.

 

 

DONATION AMOUNT: $______________ FORM OF PAYMENT: Cash Check # ____________

________________________________________________ ______________________

ADOPTER’S SIGNATURE                                               Date

Adopter’s Driver’s License Number: ______________________________

Adopter’s E-mail Address: ______________________________________

Adopter’s Address: ____________________________________________

Home Phone: _________________ Work Phone: ____________________

 

________________________________________________

RESCUE REPRESENTATIVE’S SIGNATURE

ROOM FOR ONE MORE PET RESCUE

 

DONATIONS ARE TAX DEDUCTIBLE

OUR LEGAL STATUS: Doc #N04000009645 issued October 11, 2004, on file in Tallahassee. Registered with Florida Department of Agriculture & Consumer Affairs. Copy of the official registration and financial information may be obtained from the Division of Consumer Services by calling toll-free 800-435-7352 within the state. Registration does not imply endorsement, approval or recommendation by the State. All dues and contributions are tax exempt to the full extent allowed by law. Our registration number issued by Florida Department of Agriculture & Consumer Services is CH18409. 100% of all contributions are retained by Room For One More Pet Rescue, Inc. No percentage is retained by any professional solicitor.