Home Again Dalmatian Rescue Adoption Application

Applicant:

Co-Applicant:

Physical Address:

Mailing Address:

Telephone Number:

Email is out main means of communication, please provide us with one if you have one.

E-mail Address:

Date of Birth:

What is the name of the dog you are interested in?

Is there any questions you would like to know about this dog?

Are you willing to submit to a home visit by a local rescue in your area by appointment? Yes No

Are you someone that is currently living with parents? Yes No

Your Adopting a companion animal for: YourselfChildren Friend GiftOther Please Specify:

Number of people in your family and their ages and Gender:

Do you live in a:House Apartment Mobile home Condominium Other

Do you Own Your Home? Yes No

If renting Does your Landlord allow Pets? Yes No

Landlords Name: Telephone Number:

Have you paid a pet Deposit? If so how much?

Do you have a fenced in yard? Yes No

If you do not have a fence in yard how do you plan on confining your new dog?

Do you plan on keeping this pet: Indoors Outdoors Both

If any of your dogs are outside only, please describe the dog and why it stays outside

What will happen to your pet if you move unexpectedly?

Can you provide a permanent home for this dog for the next 10-15 years? Yes No

How many hours will your new dog be left alone on a typical day?

Where does your current dog stay when left alone?

Where will your new dog stay when left alone?

Where do your dogs sleep at night?

Where will your new dog sleep at nigh?

Are you willing to keep a collar with ID tags (not just a rabies tag) on your dogs including your new dog at all times? Yes No

In what circumstances, in your mind, justify giving up a dog?Moving NewBaby Not getting along with other pets DivorceGetting out of FenceBehavior Problems Child Lost InterestGot Too BigTime consumingShedding Allergies Housebreaking ProblemsMedical Problems Aggressive Behavior Other Reasons

How many animals have you owned in the last 5 years?

Please explain what happened to each pet and how long you had the pet? If you still have them state that you do.

Were all of your pets spayed or Neutered? Yes No

If your pets are not spayed or neutered, or previous ones were not please explain why.

Are all your pets Up to Date on their vaccinations? Yes No

Are all your pets on Heart Worm Prevention? Yes No

If so what type of HW medication are they on and how often is it given?

Are all your pets on Flea and Tick Prevention? Yes No

What type of Flea and Tick Prevention do you use? How often is it given

If you do not own any animals please state what you used on previous animals, or if no previous animals please state what you plan on using on a newly adopted pet.

Have you applied to any other rescues to adopt a pet? Yes No

Have you been denied adoption by other Rescues?? Yes No

If you have been Denied, what were the reasons if known?Which Rescue were you denied from

If you can not keep this dog for any reason at any time will you give it back to HADR. Yes No

What type of food are you feeding your dogs?

What type of food are you planning on feeding your new dog?

Has any dogs under the age of 6 months old died on your property of parvo, distemper or unknown causes? Yes No

Please tell us what you know about Dalmatians:(If a Dalmatian is what you are applying for mix or purebred)

Are you aware that Dalmatians Shed Year Around?

Are you aware that Dalmatians have a unique urinary system causing them to get Bladder stones, so they have to be on special diets?

Veterinarian Name: Telephone Number:

I give permission to contact my Veterinarian to verify current animals, vaccination status and HW prevention status. Yes No

1.Personal Reference not living with you: Telephone Number:

2.Personal Reference not living with you Telephone Number:

If you have no vet (thus no animals), Which vet will you plan on using if you are approved for adoption.

By applying for the adoption of this animal, I hereby give permission to my veterinarian and my landlord, if applicable, to disclose information to Home Again Dalmatian Rescue Yes No

CONDITIONS OF ADOPTION:

In choosing to adopt a dog from Home Again Dalmatian Rescue you agree to the following conditions

To provide food, shelter and humane treatment of this animal at all times

To provide annual immunizations as required by state law

To prevent this animal from running at large (dogs must be on leash or kept in enclosed area )

To prevent this animal from being used for experimentation, fighting or other animal cruelty

To submit to an investigation should it be determined that conditions of this adoption are not being complied with

You understand that adoption fees are to reimburse the care put into the animal, Including but not limited to, spay, vaccinations, HW/Lyme disease/E Caria testing, worming, preventatives, antibiotics and most often times others, so you are not paying for the animal and, as such, are nonrefundable, and considered a donation to Home Again Dalmatian Rescue

You understand that Home Again Dalmatian Rescue does not guarantee personality or temperament. Even though Home Again Dalmatian Rescue does their best to do temperament testing and disclosed all information know about the dog, I accept full responsibility for this animal’s personality and temperament and will not hold Home Again Rescue liable for any damages caused by adopted animal if I am approved for adoption

You understand that Home Again Dalmatian Rescue reserves the right to deny your application for any reason but also has the right to reclaim said animal if conditions of the future contract are not complied with

You understand that this is just the application process, this does not guarantee you will get the dog you have applied for as Home Again Dalmatian Rescue does not adopt to a First Come First Serve basis, dogs are adopted out to the best home for that particular dog.

You understand that it can take at least a couple weeks to finish the adoption process if you are approved for adoption as a home check, follow up vet care, Contract and adoption fees, transport coordination and other things must happen, so patients is needed.

Typing your name below will serve as legal signature.

By signing below, I am attesting to the truthfulness of my answers. Falsification of any of the above information will be grounds for disallowing the adoption of rescue dog and possible removal of said dog from my home. Applicant must be 18 years of age or older. Home Again Dalmatian Rescue reserves the right to refuse any applicant.

Full Name: Date: