Dog Adoption Application

The information requested in this form will assist us in matching you to the right dog for your family, needs and lifestyle. We realize that some of the questions are intrusive, but we are sure you will understand that we are responsible for the animals we rescue as they have no one else to guarantee their lives and well-being. We take this responsibility seriously and will not adopt out to any home when we cannot feel totally confident of the adopter’s willingness and ability (financial and personal) to commit to this animal's future well-being and happiness. This application is a first step in the process and is not a binding agreement for adoption. We reserve the right to deny adoption. Our goal is to find the best suited home for each animal

An adoption fee is usually required at the time of the signing of the contract, when you receive your new pet. Be sure to discuss this with us prior to making a decision, the fee is refundable for any reason within the first two weeks of your guardianship provided it does not work out and the dog is returned safe and sound. Adoption fees cover medical expenses (spay/neuter, shots, etc usually at a drastically reduced rate). Throughout the life of the animal, if any reason should arise where you are unable to keep them, we require that s(he) be returned to me (Patrice Shearin and/or Colleen Crossan). We strongly recommend that this animal be micro chipped for safety. Please realize that you are not at liberty to dispose of this animal in any way, except to return her/him to us. The dog may not be sold, given away, put in a shelter or euthanized without the knowledge and permission of Freedom Fences, Inc.

This Application is the first step in a process that we anticipate will culminate in the placement of a healthy and temperamentally-sound animal into your home as a new family member. Steps two and three respectively, will be a veterinary check (your veterinarian will be telephoned and asked about your previous record of treatment and care of your pets) and a home check, where a member or representative of (Colleen Crossan or Patrice Shearin) will visit your home to ascertain the suitability of the living quarters for your new pet and to suggest any safety features that you may not be aware of in providing a safe and secure home for your newest member. All members of the household as well as all other pets must be present for this visit. Please don’t view this as judging. We simply want to ensure that the pet is going to a great home. A virtual home visit can be arranged.

No information offered on this form by you will be given to third parties for any purpose, (unless it is determined that you or members of your household are actively engaged as an owner, supporter or employee of a puppy mill, or participate in dog auctions, or organized dog fighting; or in the event that we are made aware that you or members of your household are guilty of acts of animal cruelty as defined by state laws, or have ever been cited for acts of animal cruelty or negligence. In which case you will be reported to authorities.)

If you are on ANY DNA ( DO NOT ADOPT) list anywhere for any reason you will not be allowed to adopt an animal

We reserve the right to refuse adoption to anyone, for any reason, at any time, in accordance with our experience and sense of responsibility for the animals in our care.

Please enter the name of the dog you are applying for (if one has not been determined, describe the size/age/gender of pet you would like to adopt):

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

How long at this address?

Phone (Home):

Phone (Cell):

Phone (Office):

Drivers License Number

License Plate Number

Are you planning on moving within the next 6 months?(Required)

Yes

What are your plans for your pets if you move?

Are you 21 years of age or older?(Required)

Yes

Do you own your own home(Required)

Yes

Name and phone number of landlord

Type of Dwelling(Required)

House

Apartment

Condo

Mobile Home

What time of day is someone usually at home?

Number of persons in your household

Ages of any under 18

Are any members of your household allergic to animals?(Required)

Yes

Who will have chief responsibility for the care of your new pet?

Over the past 5 years, how many pets have you owned? (Include current pets)

Have you ever had dogs that needed rehoming in the past?(Required)

Yes

Rehoming Reason

Specify why the dogs needed to be rehomed and how many times it occurred.

Current Pets

Type

Cat

Dog

Sex

Male

Female

Breed

Acquired From

Is this a current pet?

Yes

Please Explain

Current Pets

Type

Cat

Dog

Sex

Male

Female

Breed

Acquired From

Is this a current pet?

Yes

Please Explain

If you have more than 2 pets list additional information here.

Have you ever had a dog that had heartworms?(Required)

Yes

Please Explain the circumstances

Are your current pets up-to-date on their annual vaccinations?(Required)

Yes

What vaccinations do your pets usually get?

Have any of your pets ever been accidentally hurt or killed?(Required)

Yes

Please explain the death

Have you ever tethered/chained a dog?(Required)

Yes

If your pet lived outside, what was/is their living arrangement? Fence? Pen? Size of Either:

Who is your Veterinarian?

Veterinarian Phone Number

Are you prepared to provide your dog with an annual veterinary exam, annual vaccinations, and any necessary veterinary care as needed?(Required)

Yes

Can you provide your dog with monthly heartworm and flea/tick protection?(Required)

Yes

Is your family aware of your decision to bring a pet into your home?(Required)

Yes

Please note, it is NOT a good idea to give a pet as a surprise present.

Are you prepared to commit to a pet for 10-15 years (average life span)?(Required)

Yes

Do you agree that if you become unable to keep your pet for any reason, it will be returned to (Patrice Shearin)?(Required)

Yes

Are you aware of local vaccination ordinances and leash laws?(Required)

Yes

Have you or any member of your household ever been charged with cruelty to animals or negligence in animal care?(Required)

Yes

Why do you want to adopt a pet?(Required)

Companion

For Children

Guardian

Other

If your dog will spend time outside, describe any shelter available

Describe Your Fence(Required)

None

Chain Link

Electric

Privacy/Wood

How tall is the fence?(Required)

None

Invisible Fence

Under 4 Feet

4 -5 Feet

Over 5 Feet

Where will your pet sleep?

Where will your pet eat?

What method(s) of flea & tick control do you plan to use?

***IF the animal is TOO YOUNG to be altered OR if the animal has not be altered at the time of adoption the potential adopter has the option of having this surgery done by their vet (at their expense) or our vet (included in the adoption fee). If choosing a personal vet the surgery MUST be done by 16 weeks old OR within 2 weeks of adoption. Under NO circumstances will the dog(s) remain unaltered.

Please provide name/address/phone of a neighbor who can confirm fencing and prior/current pet ownership:

Neighbor Name

First Last

Neighbor Address

Street Address Address Line 2 City State ZIP Code

Would you like to provide any other references that can testify to your responsibility and ability to care for your animals? If so, please place their names and phone numbers below:

I understand that (Freedom Fences) reserves the right to reclaim possession of the above animal if for any reason I cannot adequately provide this animal with good food, shelter, medical care or treatment and a loving, safe environment. If (Freedom Fences) believes that the health and well-being of this animal is in question at any time, I agree to allow her or her representative to visit the animal by request at any time during his/her life with us, and (Colleen Crossan/Patrice Shearin or representative) may contact our Veterinarian for any pertinent records or information needed to that effect. Freedom Fences, Inc (AND ITS OFFICERS, BOARD OF DIRECTORS, VOLUNTEERS, AFFILIATED ENTITIES, AND/OR AGENTS) SHALL NOT BE LIABLE TO ADOPTER ON ANY THEORY OF LEGAL LIABILITY INCLUDING BUT NOT LIMITED TO THE NEGLIGENCE OF ACPBRR (AND/OR ITS OFFICERS, BOARD OF DIRECTORS, VOLUNTEERS AND/OR AGENTS), FOR ANY INJURY, DEATH OR DAMAGE DIRECTLY OR INDIRECTLY CAUSED BY PET. ADOPTER DOES HEREBY RELEASE ACPBRR (AND ITS OFFICERS, BOARD OF DIRECTORS, VOLUNTEERS AND/OR AGENTS) FROM ANY AND ALL LIABILITY, CLAIMS, SUITS, OBLIGATIONS, DEMANDS, OR CAUSES OF ACTION, KNOWN OR UNKNOWN, FORESEEN OR UNFORESEEN, ARISING OUT OF OR RELATING IN ANY WAY TO PET OR Freedom Fences, Inc RELEASE OF PET TO ADOPTER. IT IS THE EXPRESSED

Adopter's Initials

INTENTION OF ADOPTER AND FREEDOM FENCES, INC THAT THE RELEASE PROVIDED FOR IN THIS PARAGRAPH IS DESIGNED AND INTENDED TO PROTECT FREEDOM FENCES, INC (AND ITS OFFICERS, BOARD OF DIRECTORS, VOLUNTEERS, AND/OR AGENTS) FROM ANY PERSONAL INJURY CLAIMS BY ADOPTER OR OTHERS AND FROM THE CONSEQUENCES OF ANY HARM, BEHAVIOR, OR OTHER ACTION BY PET, AND FROM THE CONSEQUENCES OF ANY ACT OR OMISSION OR NEGLIGENCE ON THE PART OF FREEDOM FENCES, INC (AND ITS OFFICERS, BOARD OF DIRECTORS, VOLUNTEERS AND/OR AGENTS) IN OBTAINING CUSTODY OF PET, IN PROVIDING CARE FOR PET, IN TRAINING OR NOT TRAINING PET, OR IN FAILING TO PROVIDE TIMELY OR ADEQUATE WARNING TO ANY PERSON CONCERNING PET. Freedom Fences, Inc (AND ITS OFFICERS, BOARD OF DIRECTORS, VOLUNTEERS, AFFILIATED ENTITIES, AND/OR AGENTS) SHALL NOT BE LIABLE TO ADOPTER ON ANY THEORY OF LEGAL LIABILITY INCLUDING BUT NOT LIMITED TO THE NEGLIGENCE OF ACPBRR (AND/OR ITS OFFICERS, BOARD OF DIRECTORS, VOLUNTEERS AND/OR AGENTS), FOR ANY INJURY, DEATH OR DAMAGE DIRECTLY OR INDIRECTLY CAUSED BY PET. ADOPTER DOES HEREBY RELEASE ACPBRR (AND ITS OFFICERS, BOARD OF DIRECTORS, VOLUNTEERS AND/OR AGENTS) FROM ANY AND ALL LIABILITY, CLAIMS, SUITS, OBLIGATIONS, DEMANDS, OR CAUSES OF ACTION, KNOWN OR UNKNOWN, FORESEEN OR UNFORESEEN, ARISING OUT OF OR RELATING IN ANY WAY TO PET OR Freedom Fences, Inc RELEASE OF PET TO ADOPTER. IT IS THE EXPRESSED

The above information is truthful and correct to the best of my knowledge which I hereby certify with my

Signature

Date

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