Zoro

Name

Spouse/Partner/Significant/Other

Cell phone

Alternate/Emergency Cell phone

Address

Occupation

Spouse/Partner/Significant others’ occupation

Friend/Relative Phone

Please list all adults in the household and the hours they are typically home

Please list all children in the household along with their ages

Will the children be expected to care for the pet? If so, in what capacity?

Is the pet a gift? for whom?

Who will be the primary caretaker of your pet?

Does anyone in the home have pet-related allergies? 16.If yes, please explain:

How did you hear about this dog/cat?

Please tell us why you want to adopt a new pet:

Why are you interested in adopting from a rescue?

Have you ever had this type of animal or breed before?If yes, is the animal still residing with you?

Do you currently own any pets? If yes, what kind(s) and what is the current status of your pet(s)? ANIMAL/BREED NAME AGE YEARS OWNED HOW OBTAINED?

Are all pets currently owned spayed/neutered? Vaccinated?

Please list other pets you have owned since you have been an adult: ANIMAL/BREED NAME AGE YEARS OWNED IF NO LONGER WITH YOU, PLEASE EXPLAIN

Do you have a regular Vet? Vet Name: Vet Address: Vet Phone Number:

Do we have your permission to contact your veterinarian as a reference?

Have you ever had to give an animal away or surrendered one to a shelter? If yes, please explain:

Which of the following best describes your current living situation?

Do you have a private yard? Fenced?

Type and height of fence:

f you had to move, would you consider moving to a location that does not allow pets?

What would happen to your pets if you moved? Locally? Out of State? Out of country?

Would you describe the activity level in your household as: Low: Medium: High:

Where will your new pet stay during the day? At night?

How many hours a day will your new pet stay aloneWhere?

Are you aware there is a period of adjustment for each rescue to its new surroundings, which may include potty accidents, chewing and digging, or other ‘undesirable’ behaviors?

If the new pet makes a mistake, please describe what kind of correction you will make:

Are you willing/able to be financially responsible for all routine, unexpected and emergency medical care for your pet?

How will you socialize your dog? Dog park? Play dates with other dogs? Doggy Day Care? How Often? Other dog at home?

Where will the dog sleep at night? Dog house Garage Laundry room Kitchen Master bedroom Child’s room Bathroom Other[explain]

What outside areas are available to the dog? Fenced yard Patio Garage Balcony Dog House Unfenced common area Swimming Pool? YES______NO_______

Have you recently inspected your fence and is it secure, without holes, gaps, or low points? Y______ N______. If NO, and your application is accepted, do you agree to thoroughly inspect your fence and make any necessary repairs before the home visit? Y_____ N_______

Is there any type of lock on the gate[s]? Padlock Key Latch Other

Who has access to your yard? Gardner: Poolman: Housekeeper: Utility: Neighbor:

If you do not have a fenced yard, are you willing to take the dog out on lead at least three times a day to relieve itself? Are you planning on paper training?

How and when will your dog get exercise?

Do you plan on attending classes or any other dog activity with your dog? If yes, what kind?

Preferred level of exercise with dog? Couch potato Short walks Vigorous walks Hike/jog

When you go on vacation, who will care for care the dog?

What kind of food will you feed the dog?

Who will groom and bathe your dog?

Would your dog wear a collar?

How would you rate your level of dog owning experience? 1st time owner Beginner Intermediate Advanced OTHER

How would you discipline your dog if he or she misbehaves?

How would you train this dog? Obedience class Hit with Newspaper Firm verbal command Clicker/hand signals OTHER

How do you normally walk you dog? ON LEASH? OFF LEASH?

When on Leash I normally use: Collar only Choke chain Harness Prong collar

Are you willing to live with hair on the furniture, stains on your rugs, a warm body on your bed, and an animal that might be destructive at times?

Pets are an investment of your time and money. Can you afford to provide medical care, grooming, proper diet, shelter and exercise for your new pet?

Are you able to make a long-term commitment to care for your pet for it’s entire life span, which could be as much as 10- 20 years?

Which of the following reasons might prompt you to give up your dog?

Excessive Barking Biting _____ Digging_____ Moving____Divorce_____ Poor watchdog_____ Shedding_____ Destructive Chewing_____ Financial problems_____ Accidents indoors______ Growling at guests _____ Expensive Vet Bills _____ Allergies_____ New spouse/partner doesn’t like dog_____ Aggressive on leash______ NONE OF THE ABOVE _____

Will you agree to consult and pay for a trainer or behaviorist if any problems develop?

I understand that a home visit is required prior to final placement __________ [please initial]

I understand that a home visit does not guarantee placement __________[please initial]

I agree to provide my own collar, leash, choke chain or harness, and personal ID at the time of completing the adoption contract _______[please initial]

I understand there will be one visit after adoption to see how the dog is doing.

I understand I must microchip the dog if it isn’t done yet.

Please provide names and phone number of two non-family individuals who can serve as references:

May we contact your references and do a home visit to your home to verify the information you have

Do we have your permission to do a follow up visit after adoption?

Do you understand that if you are no longer able to care for your adopted pet, you MUST return it to Joy Haley Y ________ N _________

Do you have any additional comments that will assist us in our consideration of placing a pet with you?

INFORMATION AND REQUIREMENTS

It is vital to keep your dog ON A LEASH AT ALL TIMES outdoors if not in a fenced area.

You must agree to keep your dog or cat as a pet in your home, as a part of your family. No animal should be kept outdoors or left outside unattended for any extended period of time.

You must agree to have your rescue pet wear an identification tag at all times.

You must agree to maintain necessary vaccinations recommended by your vet and be responsible for licensing your pet according to regulations in your community.

You must contact Joy Haley and provide notification of any change in contact information from that listed on this application.

You must notify Joy Haley if you cannot keep your rescue pet for any reason.

The rescue pet may not be given to a shelter, other rescue group, or individual, without consent from

Joy Haley

I CERTIFY THAT I HAVE READ THE ABOVE AND AGREE TO ABIDE BY THE REQUIREMENTS SET FORTH. IF I QUALIFY AND RECEIVE A RESCUE PET, I WILL ACCEPT FULL RESPONSIBILITY FOR THE ANIMAL. ____________ (please initial)

If this is animal is too young to be safely spayed or neutered at this time, I understand that it is my personal and financial responsibility to have the animal altered when it reaches the age of 4-6 months. The only exception to this is if I obtain a written report provided by my veterinarian stating that spaying or neutering would be detrimental to the health of this animal. _____________

Joy Haley reserves the right to repossess the rescue pet should any portion of this contract be breached by the adopter(s) or if it is determined the rescue pet is abused or neglected in any way. ____________

I can_______ cannot_____ make a donation of at least $450

I understand that any donation or contribution is a gift freely given, not a purchase price for a dog. _______________ (please initial)

I understand that upon adopting, after 7 days, 1/2 of the donation is non-refundable_______ (please initial)

I understand that after 10 days the full donation will be non-refundable_______ (please initial)

Joy Haley reserves the right to refuse adoption to any applicant for any

reason. _______ (please initial)

This questionnaire becomes part of our contract ________ (please initial)

_______________ [INITIAL OF ADOPTER ] _____________ [INITIAL OF RESCUER]