Adoption Application

Animal of interest:

What dog are you interested in?

If no particular dog, what are you looking for in a dog?Please list behaviors, breeds, and other characteristics you hope to find:

Does everyone in the home agree to adopting a dog?

Yes

General Information:

Phone

Name

First

Last

Spouse's Name

First

Last

Address

City

State/Province

Zip/Postal

Are you over 18 years of age?

Yes

Do you currently have applications with other rescues for other dogs?

Yes

How Many Adults live in your home?

Do you have children in your home?

Yes

If yes, How many and what are their ages:

Residential information:

If you rent, we require that you obtain permission from your landlord and understand the pet policies prior to adopting. We will ask to speak with your landlord.

Do you own or rent your home?

Own

Rent

Landlord’s Name:

First

Last

Phone

Does the landlord have a pet policy restricting size or weight?

Yes

Unsure

If yes what is that policy:

Do you have a fenced in yard?

Yes

If yes, what kind of fence do you have and what is the height?

Pet Information:

How do you plan to exercise the dog?

How many hours a day will the pet be left alone?

When you are away during the day, where will the dog be kept?

Where will the dog sleep at night?

Are you willing to attend obedience course if needed?

Yes

Do pets currently live in your home?

Yes

Please list pets that you no longer have (within the last 5 years) and the reason you no longer have them:

Are all your current pets vaccinated?

Yes

No Current Pets

Are all your current pets Spayed/Neutered?

Yes

No Current Pets

Veterinarian Reference:

Please fill this section out if you have any pets in currently in the home. If you do not have a current veterinarian Too Broke Girls Rescue is willing to help you find one.

Clinic Name:

Phone

Veterinarian’s Name

First

Last

I understand that Too Broke Girls Rescue requires heartworm prevention in to form of either a monthly prevention treatment or a ProHeart Vaccination.

Personal References:

Please provide 2 personal references that are not relatives.

Reference #1:

First

Last

Reference#1 Phone:

Reference #1's relationship to you:

Reference #2:

First

Last

Reference #2: Phone

Reference #2's relationship to you:

Disclosures:

Please read the following statements carefully and initial by each one.

I hereby certify that all provided information is complete and true to the best of my knowledge.

I understand that a Rescue volunteer may conduct an interview and home check.

If I choose to keep a dog, Rescue WILL NOT be responsible for any fees incurred by myself (the adopter) due to illness or injury of the dog.

The Rescue will not be held liable for any fees associated with the dog’s expenses during the time I the adopter have ownership of the dog. (examples of expenses are but not limited to Veterinarian appointments, medications, food, training, etc.)

I understand that if I cannot keep the dog I adopted from too Broke girls Rescue, I will return the dog to the rescue and will NOT give away to another person or shelter.

I understand that depending on the return reason and time elapsed after adoption, a refund may not be possible.

I am fully aware of the risks that dogs pose and have elected to view and/or interact with one or more dogs in the care of the Rescue voluntarily. I assume all risks that exposure to dogs may pose, including but not limited to serious bodily injury and/or death.

I hereby waive, release, discharge, hold harmless and promise to indemnify and not bring suit against Rescue, its directors, officers, registered volunteers, staff and all other agents and attorneys for any referenced parties, and any parties acting for or on behalf of the referenced parties from any and all rights and claims which I have or which may hereafter accrue to me and from any damages which may be sustained by me directly or indirectly in connection with, or arising out of, my exposure to such dogs.

Yes, I accept this waiver and release Too Broke Girls Rescue from all liability

Name

First

Last

Date

If you are human, leave this field blank.

Ready to Adopt?

Attending an event in person soon? Click here to fill out our downloadable form and bring it with you!

Animal of interest:

General Information:

Residential information:

Pet Information:

Veterinarian Reference:

Personal References:

Disclosures: