Adoption Application – Tender Hearts Dog Rescue

Step 1 - Personal Information

First Name

Last Name

Date of Birth

Mobile Phone

Home Phone

Address Line 1

Address Line 2

City

State

Zip Code

How did you hear about us?

Step 2 - Household Information

Do you own, rent, or lease your residence?

Own Rent Lease

Are there any pet restrictions where you live?

Yes No

Please explain the pet restrictions

Are there any pet restrictions where you live?

Yes No

Please explain the pet restrictions

Please have your landlord contact us to confirm that adopting a dog in your home is acceptable. You will not be able to adopt until we receive positive confirmation.

How long have you been at this address? (Years)

How long have you been at this address? (Months)

What type of yard do you have?

No yard Unfenced yard Partially fenced yard Completely fenced yard

If you don't have a fenced in yard, you must agree to keep your adopted dog on a leash at all times while outside.

I agree

If you don't have a fenced in yard, you must agree to keep your adopted dog on a leash at all times while outside.

Who will be the primary caretaker of your animal(s)?

How would you describe your level of experience with dogs? (check all that apply)

Have never had a dog Have had one or more as an adult Have experience housing/boarding animals at a facility or with a pet-sitting service Have experience working in a veterinary hospital Had a childhood dog Have experience working with on-going medical problems with a personal dog Have experience working with behavioral problems with a personal dog Have experience as a professional dog trainer

If you have previous foster/rescue experience, please describe:

Do you have experience with: (check all that apply)

Small dogs Medium dogs Large dogs

Please describe experience with specific breeds, if any:

Is there any breed of dog or situation you would not be willing to adopt? Please describe:

How many hours during the average day will this dog spend WITHOUT a human?

Where will this dog be when alone?

Where will this dog be when someone is home?

Where will this dog sleep at night?

Do you have a preference on the dog's size?

Yes No

What is your dog size preference?

Do you have a preference on the dog's breed?

Yes No

What is your dog breed preference?

Do you have a preference on the dog's age?

Yes No

What is your preferred dog age?

Please tell us anything else you would like us to know to help match you up with the right animal:

Step 5 - References

Reference 1

Reference 1 First Name

Reference 1 Last Name

Reference 1 Phone Number

What is your relationship with Reference 1?

Reference 1 Additional Information (optional)

Reference 2

Reference 2 First Name

Reference 2 Last Name

Reference 2 Phone Number

What is your relationship with Reference 2?

Reference 2 Additional Information (optional)

Referral 3

Reference 3 First Name

Reference 3 Last Name

Reference 3 Phone Number

What is your relationship with Reference 3?

Reference 3 Additional Information (optional)

Step 6 - Waiver

This Adoption Liability Waiver (Waiver) is by and between Tender Hearts Dog Rescue (THDR) and its Adoption Parents and includes the following terms:

LANDLORD’S APPROVAL – I certify that I have discussed the idea of adopting a dog with my landlord. I have approval to adopt a dog.

I AM MAKING A COMMITMENT TO FOSTER THIS DOG FOR THE FIRST 2 WEEKS FROM TODAY’S DATE – I understand that I am fostering this dog for the first two weeks, at the end of two weeks' time, I will have made a decision to either a) return the dog to THDR if the foster arrangement is not working out, b) continue fostering the dog, or c) formally adopt the dog.

I ACCEPT THIS DOG AS IS – I hereby accept this dog as is and accept all risk of ownership of this dog. I hereby fully and completely release Tender Hearts Dog Rescue, its foster parents, its agents, and its volunteers from any claim, cause of action, or liability, whether known or unknown, arising out of damage this dog may inflict upon any person or animal.

I AM AWARE OF AND UNDERSTAND THE FOLLOWING RETURN POLICY – Once placed in a new environment, most dogs need an adjustment period and additional training in order to fit in to their new home. I understand that it is my responsibility to provide this adjustment period and training, and to be as flexible and understanding as possible during this time. I understand that if I return the dog during the 2 week foster period, I will be entitled to a 50% refund of my adoption fee. After the 2 week trial period has passed, there will be no refund.

TENDER HEARTS DOG RESCUE MAKES NO WARRANTY – I understand that there may be limited information regarding the named dog and Tender Hearts Dog Rescue does not make any warranty as to its age, health, breed, habits, temperament, or disposition. All known information with respect to this dog and its physical condition has been represented by Tender Hearts Dog Rescue in good faith.

FEES – I understand that the Tender Hearts Dog Rescue is under no obligation to reimburse me for any medical expenses, miscellaneous expenses, or fees incurred in connection with this dog. I, as the adopter, will pay the Tender Hearts Dog Rescue an adoption fee, to be determined at a later date, at the time the adoption contract is executed.

DOG HEALTH – THDR never knowingly adopts out a sick dog and supplies only information to which it has direct knowledge. I take full responsibility for vet bills. If the dog is injured or becomes ill, I will take whatever steps necessary to ensure the wellness of my dog.

I WILL BE RESPONSIBLE FOR MY PET – I will not remove the Tender Hearts Dog Rescue ID tag until I have made my own ID tag. I will not allow this dog to run at large or to become a public nuisance. I will keep my dog in a safe, fenced area, and will never chain it up as a means of restraint. Dogs must sleep indoors at night, have an identification tag on them at all times, and be licensed. In the event that this dog becomes lost, I agree to make every reasonable attempt to locate the dog.

RELINQUISHING THIS DOG – If for any reason I am unable to care for this dog, I will contact Tender Hearts Dog Rescue to determine the appropriate course of action. I understand that Tender Hearts Dog Rescue is under no obligation to accept responsibility for the dog’s return. I agree not to relinquish this dog to any other individual or organization (animal control agencies, friends, relatives, other rescue groups, etc.) unless I have communicated with a representative of Tender Hearts Dog Rescue and received authorization to do so.

WE MAY RECLAIM THIS DOG – I understand that if the Tender Hearts Dog Rescue determines that I have mistreated this dog or have otherwise failed to perform my obligations under this contract, or if I have misrepresented myself, THDR may reclaim the dog immediately, without refunding any portion of my adoption fee, and reserves the right to pursue legal action against me if necessary, and at my expense.

ADOPTING THIS DOG FOR LIFE – I understand that I am adopting this dog for the duration of its life. I will not give this dog to anyone as a gift, resell it, abandon it, or allow it to be used for experimental or medical research purposes.

INDEMNIFICATION – Adopter does hereby release the Tender Hearts Dog Rescue from any and all liability, claims for damage, injury or other such related claims which may arise from the operation of this agreement or actions of the dog.

IN SIGNING MY NAME TO THIS DOCUMENT, I DO HEREBY ACKNOWLEDGE THAT (1) I HAVE READ THE CONTRACT’S PROVISIONS; (2) I UNDERSTAND THE CONTRACT’S PROVISIONS; and (3) I AGREE TO ABIDE BY THE CONTRACT’S PROVISIONS.

I agree to the Adoption Liability Waiver