Your Name:
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Your Address:
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Email Address:
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Home Phone:
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Work Phone:
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List names and ages of other
adults in home and their
relationship to you:
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Names and
ages of Children:
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Your occupation and the
name of your employer:
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Your spouse’s occupation and
the name of his/her employer:
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Type of
Home:
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Do
you own or
rent your home?
(select one):
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If
rent, Landlord
name and phone:
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Do
you have a Yard?
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Is
it Fenced?
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Age, Type,
Height of Fence:
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Where will the dog stay when
you are not at home?:
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How many hours a day will
the dog be home alone:
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Where will the dog
sleep at night?:
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What do you do with your
animals while on vacation?
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List other animals currently in
your home (breed, age, sex.
neutered/spayed, temperament
with animals and people.
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Please list prior animals and
what happened to them.
Include breed, age, name.
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Reference #1
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Reference # 2
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Please list 2 personal references.
Include name, address, phone
and their relationship to you
(relative, friend, etc.)
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Please list your veterinarians
name, address and phone
number:
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May we contact
your veterinarian
for a reference?
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Are you agreeable to returning the
dog to A Tail to Tell, Inc., if you are
no longer able to keep the dog?
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Please describe any
situations that would
cause you to give up a pet:
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Why do you want to adopt
a rescued/ puppy mill dog?
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Why do you want to adopt
this particular dog?
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Are there any other
things we should know?
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Are you agreeable to signing
an adoption contract for the
adoption of this dog?
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Our adoption donations are as
follows...
12 weeks old - 1 year old - $350.00
2 years old - 5 years old - $250.00
6 years old - 100 years old - $150.00
Are you agreeable to this amount...
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I
declare that the information I have provided in this application is
complete and correct. I further declare that I am financially and
physically able to care for a rescued dog, specifically, a special
needs dog. I understand that proper food and veterinarian care may be
costly, and I am able and willing to meet the needs of my adoptive
dog. I understand the requirement and grant permission for Home
Checks at random both prior to and following adoption. I submit that
if a Home Check reveals falsification or misrepresentation of any
facts on my part, A Tail To Tell, Inc. (the rescuer), reserves the
right to either refuse adoption or to nullify the adoption and reclaim
said
dog from my premises, without reimbursement of the adoption donation.
I release A Tail To Tell, Inc. (the rescuer), from any liabilities I
may incur from the adoption process
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Signature:
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Date Signed:
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