RRAR Dog Adoption Form Name * First Name Last Name Name of Pet you wish to adopt: * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Age * Driver License State * Driver License Number * Employer * Number Of Years at Job * Reference 1 Name * First Name Last Name Reference 1 Phone * (###) ### #### Reference 1 Relationship * Reference 1 Years Known * Reference 2 Name * First Name Last Name Reference 2 Phone * (###) ### #### Reference 2 Relationship * Reference 2 Years Known * Do you Live in a: * House Townhouse Apartment Condo Other If other please specify: Your home is: * Owned, by you or your spouse/life partner Owned by someone else within the house Rented directly from the owner or through a management company Rented as a part of a group of roommates. Other: If other please specify: If renting, is your name on the lease? Yes No N/A If renting do you have the landlord permission to have a dog? Yes No N/A Who Shares your home? * Are there children in the home? Yes No If Yes How many children? Age(s)? If there are children, what experience do they have around dogs? Do you plan to move soon? Yes No Is your yard fenced in? Yes No If not, how do you intend on exercising your newly adopted dog? If your current relationship/living situation were to change and you were no longer able to care for the pet, a new application must be submitted and approved to transfer ownership. Please type your name to indicate you understand * First Name Last Name Do you currently have any pets? * Yes No If Yes, how many? Type of pet: Dog Cat Other N/A Pet's Name Breed/if other species please specify: Age Temperament? Anything else we should know about this pet? Are they up to date of their Vaccinations? Yes No Are they spayed/neutered? Yes No Type of pet: Dog Cat Other N/A Pet's Name Breed/if other species please specify: Age Temperament? Anything else we should know about this pet? Are they up to date of their Vaccinations? Yes No Are they spayed/neutered? Yes No Type of pet: Dog Cat Other N/A Pet's Name Breed/if other species please specify: Age Temperament? Anything else we should know about this pet? Are they up to date of their Vaccinations? Yes No Are they spayed/neutered? Yes No Type of pet: Dog Cat Other N/A Pet's Name Breed/if other species please specify: Age Temperament? Anything else we should know about this pet? Are they up to date of their Vaccinations? Yes No Are they spayed/neutered? Yes No Who is your veterinarian? * Name of the Clinic: * Veterinarian Phone Number (###) ### #### RRAR Does NOT approve chaining a dog or leaving them outside without adequate food, water or shelter. “Yard Abandoning” a dog adopted through RRAR would be a breech of contract and legal action will be taken. Please Type Initials that you understand. * Why have you chosen to adopt a Dog? * Where will your dog new dog be kept? * Indoors Indoor/Outdoor Outdoors Percentage of time Indoors: Percentage of time Outdoors: Have you had experience or behavioral knowledge of the dog breed you have chosen to adopt? * Yes No Do you understand that the average life span of a dog is 15 years and that you will be physically, emotionally and financially responsible for the dog throughout its life? * Yes No Do you understand that dogs need copious amounts of attention and will require daily exercise and training to keep their mental and physical health optimal? * Yes No Do you understand that in general, dogs take AT LEAST two (2) weeks, sometimes longer, to adjust to a new home and/or other pets and people. Will your new dog get the time and space he or she needs to make the adjustment? * Yes No Which of the following reasons might force you to give up your dog? (Check all that apply): * No reasons Behavioral Issues Marking, urinating, deficating in the home? Financial Issues Not getting along with other pets Other reasons: Other reasons you might give up a pet: Have you ever abandoned or given up a pet? * Yes No If so, what were the circumstances? HOME CHECK: Prior to your dog adoption you will be required to agree to a home check. A home check will be performed either in person or via video chat at which time an RRAR adoption specialist will ask a few questions and request to see specific areas of your home. This check is done solely for the purpose of ensuring the safety of the adopted pet. * Yes No ADOPTION DONATION: Prior to your dog adoption you will be required to make an adoption donation of no less than $150. This donation is NON-REFUNDABLE and can be paid via Cash, Check or PayPal. Please note: All pets adopted through RRAR have been vetted through Goodwin Animal Hospital, Pike Road and given a clean bill of health. If they are adult animals they have been fully vaccinated, spayed or neutered, treated for internal parasites, been given heartworm/flea treatment and microchipped. If they are juvenile animals they have been given their first round of vaccinations, treated for internal parasites, been given heartworm/flea treatment and microchipped. Due to being under age, the spay or neuter procedure will be completed at time of sexual maturity and the final vaccination administration will be done. No additional donations required, but they are ALWAYS greatly appreciated. * Yes No SIGNATURE OF ADOPTION: By signing below I understand and agree that giving false information in response to any questions above will disqualify me from adopting a pet from RRAR and will nullify all agreements between me and RRAR. Typing your name constitutes agreement to the above requirements: * First Name Last Name Date * MM DD YYYY Thank you our adoption team will reach out to you soon!
