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Don't BULLY Me Rescue Texas Adoption Form

Don't BULLY Me Rescue

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"Saving Texas Death Row Pits"
PO Box 5481
Lago Vista, Texas 78645
Email: Contact Page

CANINE ADOPTION APPLICATION

Please give careful consideration to adopting! Be sure your lifestyle allows the time, patience and expense this pet will need over the years. Adding a pet to your family is a 10 to 15 year commitment. Animals are not toys or short-term commitments and they are NOT disposable.

Procedure: Completely fill out and sign the application. You will hear back within 10 days or please assume your application was not selected. Applications that are selected will go through all necessary checks to ensure a proper home. If the adoption is approved, an adoption contract will be signed and adoption fee paid.
Adoption Fee payable to Heather Morris/Don't BULLY Me RESCUE IN the form of Money Order, Cash or Check



Date *

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Applicant's Information

Applicant's Full Name *

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Age *

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Co-Applicant's Full Name *

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Relationship to Applicant *

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Street *

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City *

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State *

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Home Phone (111-222-3333) *

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Cell Phone (111-222-3333)

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Email *

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Employer Name *

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Occupation *

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Employer Phone (111-222-3333)

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Co-Applicant's Employer Name *

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Co-Applicant's Occupation *

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Co-Applicant's Employer Phone (111-222-3333)

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Problems With This Form? Please make sure every question is answered!




Canine Information

Name of dog you are applying for?

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Breed

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How did you become aware of this dog?

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Why do you want to adopt a dog? *

Please choose at least one
If Gift, Protection or Other, please explain

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What are you looking for in a dog?

Age *

Please choose at least one
Sex *

Please choose at least one
Coat *

Please choose at least one
Color Preference

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Personality

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Health preference *

Please choose at least one
Where will the dog live? *

Please choose one
Please explain further about where the dog will live. *

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Are you willing to take the time to housebreak a dog, and do you understand that changing a dog's environment may cause the dog to have accidents? *

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If you are applying for a puppy or dog that is not housetrained, how will you housetrain?

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What steps have you taken to prepare for a new dog? *

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Have you done research on the breed of dog you are interested in? *

Please choose one
Why do you want this breed?

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Are you willing to obtain an appropriately sized crate if recommended? *

Please choose one
Do you plan to go to a professional dog trainer and/or obedience school? *

Please choose one
If no, why?

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If yes, who?

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If behavioral issues should arise, what actions will you take?

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Who will care for and exercise the new dog? *

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How many hours will the dog be left alone during the day? *

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How many hours will the dog be left alone at night? *

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When no one is home where will the dog stay? *

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Where will the dog sleep at night? *

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Will the dog be allowed on furniture? *

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Will the dog have free run of the house? *

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If and when you travel where will the dog stay? *

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If you have to move what will you do with your new dog? *

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Are you aware of your local ordinance concerning dog licensing? *

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Are you aware of your local ordinances concerning leash laws? *

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Have you ever been cited for any dog related ordinances? *

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Does your town or city have any Breed Restrictions? *

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If Yes, what are they?

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Do you agree the dog will NOT be used for fighting, breeding, illegal activities or be found at any time in a location where is presence is illegal? *

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Are you aware dogs can shed all year long? *

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Have you considered the extra expenses that will come with owning a new Dog?

The cost of owning a dog typically runs from $500 to $1500 per year for basic food, routine veterinary care, vaccinations and boarding -- but not including grooming. If a dog is injured or gets seriously ill, extra veterinary care can cost hundreds to thousands of dollars. *

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Have all household members met and agreed on a new dog? *

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Describe the kind of situations where you might return your adopted dog. *

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What reasons do you feel are valid for giving up a pet? *

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Other (please explain)

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PET AND VETERINARY HISTORY

Have you ever had to give up ownership of a pet? *

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If yes, please explain

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CURRENT PETS

Do you currently have any pets? *

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Current Pet 1

The pet's name as registered at the vet's office?

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This pet's veterinarian's name?

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This pet's veterinarian's phone? (111-222-3333)

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Name of person on file with vet?

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Type of pet/breed

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Gender

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Age

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Indoor/Outdoor

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Current Pet 2

The pet's name as registered at the vet's office?

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This pet's veterinarian's name?

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This pet's veterinarian's phone? (111-222-3333)

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Name of person on file with vet?

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Type of pet/breed

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Gender

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Age

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Indoor/Outdoor

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Current Pet 3

The pet's name as registered at the vet's office?

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This pet's veterinarian's name?

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This pet's veterinarian's phone? (111-222-3333)

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Name of person on file with vet?

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Type of pet/breed

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Gender

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Age

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Indoor/Outdoor

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If you currently have no pets, please list pets over the past 10 years.

PAST PETS


Past Pet 1

The pet's name as registered at the vet's office?

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This pet's veterinarian's name?

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This pet's veterinarian's phone? (111-222-3333)

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Name of person on file with vet?

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Type of pet/breed

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Gender

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Age

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Indoor/Outdoor

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Past Pet 2

The pet's name as registered at the vet's office?

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This pet's veterinarian's name?

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This pet's veterinarian's phone? (111-222-3333)

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Type of pet/breed

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Name of person on file with vet?

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Gender

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Age

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Indoor/Outdoor

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Past Pet 3

The pet's name as registered at the vet's office?

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This pet's veterinarian's name?

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This pet's veterinarian's phone? (111-222-3333)

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Type of pet/breed

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Name of person on file with vet?

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Gender

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Age

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Indoor/Outdoor

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Name of veterinarian you will use for your new pet? *

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Contact info for veterinarian you will use for your new pet? *

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Problems With This Form? Please make sure every question is answered!





HOUSEHOLD INFORMATION

Have all household members been around pets? *

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Is your residence: *

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If other was chosen, please explain.

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If you live in a Condo or Rent – Does the Association or Landlord have Breed or Size Restrictions?

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If you live with Parents, Friends or Rent – Do you have permission to have a dog?

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If you Rent please provide Name & Telephone number of Landlord.

Landlord Name

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Landlord Phone *

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How long at current residence? *

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If you rent and live at current residence for less than 2 years, list the name and contact info for prior Landlord.

Landlord Name

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Landlord Phone

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Is your yard fenced in? *

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If yes, fence type and height?

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Does the fence belong to you?

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If no, please explain

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Is fence attached to the house?

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Any Holes or Gaps in the Fence?

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If holes or gaps can the dog get out?

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If No fence, do you plan to install one?

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If yes, please explain

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Do you have Tie-Outs?

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Do you have Overhead Runs?

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Number of children in household? *

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Number of adults in household *

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Please list all members living in household

Name 1 *

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Age 1 *

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Name 2

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Age 2

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Name 3

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Age 3

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Name 4

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Age 4

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Name 5

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Age 5

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REFERENCES
Please provide names and contact info for two references, not related to or living with you.

Name 1 *

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Address 1 *

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Phone 1 *

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Relationship to You 1 *

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Name 2 *

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Address 2 *

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Phone 2 *

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Relationship to You 2 *

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ADDITIONAL INFORMATION

Please provide any additional information you would like us to know:

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AGREEMENT AND SIGNATURE

By signing this application I attest that the information provided is true and accurate and understand false information will result in denial of adoption. Also, if an omission or untruth is discovered after an adoption takes place, Don’t BULLY Me Rescue reserves the right to annul the adoption and reclaim the animal. The adoption decision is dependent on many factors, including but not limited to the compatibility of the family to the individual animal. I understand it is the Don’t BULLY Me Rescue’s prerogative to decide which home is most appropriate and that their decision is final.

If it is decided that at anytime your cannot keep the animal you adopted, he or she needs to be returned back to Don’t BULLY Me Rescue.

While Don’t BULLY Me Rescue makes every effort to ensure that all animals available for adoption are healthy, it is possible that any animal may have an underlying health issue unknown to Don’t BULLY Me Rescue or our veterinarian. All adults have been examined by a veterinarian, received all necessary vaccinations, been combo tested for heart worms and spayed or neutered. All puppies have been examined by a veterinarian and have received all age appropriate vaccinations. I hereby agree to hold harmless and to indemnify Don’t BULLY Me Rescue volunteers, agents and/or veterinarian, for any health issues that may arise after adoption.
I, the undersigned, hereby specifically and forever release, discharge and hold harmless the Don’t Bully Me Rescue, its agents, and any other person, firm or corporation charged or chargeable with liability, their heirs, administrators, executors, successors and assigns, from any and all claims, damages, costs, expenses, loss of service, actions and causes of action in relation to adoption of this animal.

I hereby authorize the Don’t BULLY Me Rescue to receive information from Veterinarians and others listed on this application.

Signature *

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Don't BULLY Me Rescue USE ONLY

Date Application Received:

Received By:

Group Name of Canine:

References Done By:

Approved By:

Denied By:

Date Adopted:

Receipt # and Amount:

Medical Records Given:

Medical Records need to be mailed:

Microchip:

Adoption Agreement Signed:


Problems With This Form? Please make sure every question is answered!