ADOPTION APPLICATION Date of adoption______________ Rescue Tag ID # _____________ Medical Records_________ ____ Today's Date: ___________ Driver's License #______________ date expires ______ Name : ______________________________________ Address: ____________________________________ City: _______________________________________ State: __________________ Zip: _________________ Tel: (home) ____________________ (bus) _____________________ (cell) ________________ E-Mail: _______________________________ 1. How did you hear about us? _______________________________________________________ 2. Do you have any other pets now? Yes ___ No ___ If yes, please describe them: _______________________________________________________ 3. When was your pet last to the veterinarian? ______________________________________ 4. Name/Address of veterinarian _____________________________________________________ 5. Do you have previous experience as a guardian of a companion animal: Yes_____ No____ If yes, please describe fully:_______________________________________________________ 6. Do you live in a: House____ Apartment___ Townhouse_____ Other___________ 7. Is your yard fenced? Front: Yes No Back: Yes No 7a. Type of fence: wood brick chain link other 7b. How tall is the fence? Front:__________ Back: ___________ 8. Will this pet live: indoors outdoors both 8a. Will this pet sleep: indoors outdoors 9. If you were to move, what would happen to your pet? _____________________________________________________________________________________ 10. How do you feel about spaying/neutering animals? ________________________________ญญญญญญญญญญญญ _____________________________________________________________________________________ 11. Have you had experience training dogs? Yes No 11a. Who will train this dog? _______________________________________________________ 12. Will you (if necessary) attend dog obedience classes with your pet? Yes No 13. Do the costs of altering, vaccinations, medical care, licensing, grooming or general upkeep present any problems financially for you? Yes No 14. Would you install a doggie door for your pet? Yes No 15. Can you see this pet as part of your family and keeping it for the rest of it's life? Yes No 16. Are you adopting this pet for yourself? Yes No If not you, please name: ________________________ 16a. How many members in household? ________ Describe _____________________________________________________________________________ 17. Would you be interested in saving a pet's life by being a temporary foster home? Yes No 18. Any information that would be helpful/pertinent to your application: ANY MISREPRESENTATION BY APPLICANT WILL RESULT IN PET BEING RECLAIMED ADOPTION AGREEMENT Pet:________________________ Breed:______________________ Sex: ___ male ___ female Altered? Yes No Date of Vaccinations:________ DHLP-P ________ BORDETELLA ________ RABIES I/We agree to adopt the pet described above, and by so doing, accept the terms of this Agreement as set forth below. I/We understand and agree that BEAGLES AND BUDDIES reserves the right to reclaim the pet if any of the following conditions are not met. BEAGLES AND BUDDIES may repossess the animal if we have reason to believe that the pet is being mistreated, abused (verbally or physically), neglected, or is in an unhealthy condition. I/We further understand and agree that a BEAGLES AND BUDDIES representative may make a follow-up home visit at a mutually convenient time, to ascertain that all conditions are being satisfied. If I/We fail to comply with any of the terms of this Agreement, I/We will reimburse BEAGLES AND BUDDIES for any and all reasonable costs incurred to reclaim and remedy the breach of contract, including but not limited to attorney's fees and costs of suit. The adoption application on the reverse side is incorporated herein by this reference. 1) The dog will be housed at my/our home as a family pet and shall have access to the residence. He/She will not be restricted to the yard nor tied there. Beagles & Buddies' policy is to place animals as family pets. A lawsuit will be filed against any person adopting an animal for any other purpose whatsoever, including guard dog service. 2) I/We will provide veterinary care and treatment when necessary, including an annual distemper booster (DHLP-P). I/We will give him/her proper food, shelter, and fresh water at all times. 3) A personalized identification tag with my/our name and phone number shall be kept on the dog at all times. BEAGLES AND BUDDIES rescue tag shall also be worn. The dog shall be leashed when on public streets, parks, etc., and never transported in the back end of an open truck/pick-up. 4) If for some reason I/We are unable to keep or provide adequate care for this pet, or I/We shall contact BEAGLES AND BUDDIES. I/We will not sell or give this pet to any other person, friend, relative, organization, medical laboratory, pound or animal shelter. 5) B&B will always accept the return of any dog adopted from us - whether it's one day or l0 years after adoption - for any reason. 6) I/We will notify BEAGLES AND BUDDIES of any changes in my/our address and telephone number if we move and also will inform BEAGLES AND BUDDIES if this pet becomes lost or deceased. 7) I AGREE TO CALL BEAGLES AND BUDDIES WITHIN 2 WEEKS FROM ADOPTION DATE WITH A REPORT OF THE DOGS PROGRESS WITH HIS NEW FAMILY AND SURROUNDINGS. From this date forward, I hereby release BEAGLES AND BUDDIES from any liability for injury or property damage arising from ownership of the pet, and any medical care incurred after this date. I have read and understand the terms of this agreement and enter into it freely and voluntarily. Signed: ________________________________________________ Date: ____________