Adoption Application

Date *

Name of Desired Pet (Name found in Petfinder Listing under "More about ..." *

Your First Name *

Your Last Name *

Email *

re enter Email *

Street Address *

City *

State *

Zip Code *

Phone (cell) *

Best time to call contact you:

Phone (home)

Place of Employment *

Phone (work)

How did you hear about AHR? *

How far are you willing to travel to pickup your rescue dog? *

Please list all members of your household and their ages –INCLUDING the applicant-:

All Humans by name and ages including yourself (we do not adopt to anyone under 21 yrs. of age) *

Names & ages; including the applicant):

All Dogs Names, Gender, Age, Breed, Altered?

Name, gender, age, breed, altered?

All Cats Names, Gender, Altered?

Name, gender, age, breed, altered?

Other Pets Names Species

Type, name, age?

Does anyone in your household have allergies or asthma? *

Yes

No

If YES, who/kind?

Are you aware that dogs can shed all year long? *

Yes

No

Who will care for, train and exercise your rescue dog? *

What training methods will you be using: ie: obedience school/spray bottle/firm verbal commands etc? *

How will you exercise your rescue dog? *

What housetraining method will you be using? *

What will you do if you find that your dog has urinated or defecated in the house? *

Will the dog be allowed on the furniture? *

Yes

No

Will your dog(s) be allowed free run of the house? *

Yes

No

How many hours per day will your dog(s) be home without humans on a regular basis? *

Where will the dog(s) be when you are not home? *

Are you familiar with the use of a dog crate to train and/or confine the dog during your absence or at night?

Yes

No

(adult dogs should never be left for more than 6 hrs in a confined crate, puppies 3hrs)

Are you planning to use a crate? *

Yes

No

If the dog is not housetrained, are you open to crate training? *

Yes

No

If NO, Please explain

What will you do with your dog(s) if you need to be away from home overnight? *

Will the rescue dog…..

be tied outside? *

Yes

No

live outside? *

Yes

No

be walked daily? *

Yes

No

allowed to run free outside of a fenced yard? *

Yes

No

have annual vet check-ups? *

Yes

No

receive formal obedience training? *

Yes

No

If you move, what will you do with your dog(s) and other pets? *

If you were unable to keep this dog, would you return it to Almost Home Rescue as required by our adoption contract? *

Yes

No

Are you aware of and do you understand the state/local ordinances concerning:

Dog licensing? *

Yes

No

Leashing / leash laws? *

Yes

No

Are you aware that costs of maintaining a dog can average $500-$1000 or more a year (food, annual check ups & shots, heartworm & flea/tick prevention, grooming, etc.); and may require expensive medical care for unexpected emergencies? *

Yes

No

Do you have Pet Medical Insurance? *

Yes

No

Please list any pets by NAME that you have owned, given away, or surrendered in the past, how old they were and ultimately what happened to them. (if they have passed away in the last 5 yrs please include their name & the year they passed) *

References

VET REFERENCES WILL BE CHECKED: APPLICANTS: PLEASE CHECK WITH YOUR VET TO MAKE SURE YOUR PETS ARE UP TO DATE AND TO GIVE THEM PERMISSION TO SPEAK WITH AN AHR VOLUNTEER

Are all pets currently in your home altered and up to date with vaccinations (indoor cats included)? *

Yes

No

We currently don't have any pets

If any of your pets are not up to date, not altered, or receive titers tests: please list and explain:

May Almost Home Rescue contact your vet for a vet reference *

Yes

No

We have never had any pets

Please provide your veterinarian’s contact information and the full name of the person on the account associated with each pet (include any/all vets you have used for vaccinations/heartworm preventative in the last 5 years). Please provide Name, Address and Phone number and contact your veterinarian to give permission for them to speak with an AHR representative *

Include name, address and phone numbers

May we visit your home prior to the application approval? *

Yes

No

Would you allow a follow-up home visit from Almost Home Rescue after this adoption? *

Yes

No

Do you own or rent your home? *

Rent

Own

How long at current residence? *

If you rent, has your landlord provided permission for you to have a dog? Are there any restrictions on breed or size? We will need to contact your landlord to confirm.

Yes

No

Please provide your landlord’s name & phone #:

Do ALL household members want to adopt a dog? *

Yes

No

If there are no young children living in your home, will your rescue dog have regular contact/socialization with any children under the age of 10? *

Yes

No

If yes, describe:

If there are no other animals currently living in your home, will your rescue dog have regular contact / socialization with others? *

Yes

No

If yes, describe:

Do you have a fenced yard? *

Yes

No

If yes, describe the height and type of fence, as well as the approximate size of the fenced in area

If you don’t have a fence, are you willing to install one? *

Yes

No

What type of containment are you willing to install?

Ie:Chain link, Electric/Perimeter/Invisible, Privacy etc.

Do you have dog tie-outs? *

Yes

No

If Yes, Length of Tie; Average time spent on tie per day

Do you have overhead runs? *

Yes

No

If Yes, Length of Run; Average time spent on tie per day

What would you do if one of your pets requires significant and possibly expensive medical attention? *

What amount do you feel is a reasonable amount to spend if a dog were seriously ill or injured? *

Preference of the type of dog you would like to adopt:

If you selected other, please explain:

Sex *

Male

Female

No Preference

Activity / Energy Level *

Low - couch potato

Medium - Two 30 min walks per day

High - Two 1-hour walks (ie: springers, brittany’s, very mixed herding breeds)per day

Herding breeds (full or close to full blooded) – Two -1 hour running/agility/fetch/flyball etc sessions per day (not walking)

Breed or Mix preference:

Color:

Basic personality traits:

Would you consider a special needs or handicapped dog for a permanent (but controllable) condition?

Yes

No

Do you have an application for another dog in with another Rescue or Shelter?

Yes

No

Anything you would like to add?

I agree to the terms above:

Yes I agree

No I am unable to agree at this time

This is an ADOPTION CONTRACT

This is an ADOPTION CONTRACT, you need to bring it with you upon picking up an adopted dog. You do NOT need to sign the contract prior to adoption, but you do need to read it. At this point: You only need to check “Yes I agree” and submit your application to Almost Home Rescue for us to commence processing your application. If you check “No I cannot agree at this time” then your application will not be processed. WHEN YOU CHECK “Yes I agree” BELOW, YOU ARE DEEMED TO HAVE AGREED TO ALL OF THE TERMS AND CONDITIONS CONTAINED IN THIS CONTRACT. THESE TERMS AND CONDITIONS APPLY TO ANY DOG YOU ADOPT FROM ALMOST HOME RESCUE UNLESS EXPRESSLY SUPERSEDED BY A DIFFERENT CONTRACT WITH ALMOST HOME RESCUE SPECIFICALLY REFERENCING THIS CONTRACT. THERE IS NO FEE WHATSOEVER FOR SUBMITTING, AND ALMOST HOME RESCUE’S PROCESSING, OF YOUR APPLICATION. Thank you for filling out the adoption application. By electronically submitting this application, I/we understand that this is the first step of the adoption process. I/we attest that the information provided on this application is true and accurate to the best of my/our knowledge. I/we have retained a copy of this application for my/our records and understand that completion and submission of this application does not guarantee or entitle me/us to adoption of a rescue dog. By submitting this application, you also are attesting that you are at least 20 years old. 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. Not everyone that desires a pet is ready to properly care for one. I understand all of the questions and have completely read the application and understand that this dog MUST be indoors and this dog will not live chained/penned outside unattended. I understand that I can return this dog to Almost Home Rescue within two weeks 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 dog, I will call Almost Home Rescue at 802-866-0422, and undergo a 14 day waiting period in which 1) a representative may work with me to resolve any issues with the dog, or 2) will allow AHR time to find an appropriate foster home. The 14 day waiting period may be waived with approval from the President or Vice President of Almost Home Rescue. I understand that I am not authorized to release this 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 dog in it’s lifetime, the dog will be returned to Almost Home Rescue. By electronically submitting this form to Almost Home Rescue or by signing/typing in the fields below, and submitting this application to any Almost Home Rescue volunteer by email or in person, you are legally bound to this contract. The statements, terms and conditions of this application (including without limitation the return policy) applies to any and all dogs I adopt from Almost Home Rescue, regardless if named in this application or not, until a new or different application is submitted by me to Almost Home Rescue. An adoption fee is required for all dogs and is listed in the dogs bio. Your submission of this application electronically is also confirmation to Almost Home Rescue that you understand the fees described above. We make no guarantees in reference to the health and/or temperament of the dog. The dog is adopted “AS IS” and the adopter assumes responsibility for the treatment of all existing conditions or any other conditions of physical or temperament changes that may occur. While the rescuer makes every effort to place only healthy animals, the rescuer cannot guarantee the health of any animal. The rescuer shall not be held responsible for any medical expenses which may be incurred, hereby expressly excluding any implied or express warranties, merchant ability, or fitness for any particular purpose, including without limitation and warranties regarding health, temperament or whether the animal is housebroken. We do not refund adoption fees if the dog is returned after two weeks. If we determine that the match was just not an appropriate fit, you may choose another dog. This is a legally binding contract. Almost Home Rescue PO Box 9421, #377 So. Portland, ME 04116-9421 Adoptions_AHR@yahoo.com