Creston, B. C. V0B 1G0
PART A - DESCRIPTION OF PET
Paws Tag No.
Which dog are you interested in adopting?
If you are not interested in a specific dog, please indicate what characteristics you are most interested in (eg. Age, gender, personality. . . .)
PART B - APPLICANT INFORMATION
Date:
Full Name:
Residential Address:
Mailing Address:
Phone - Home: Work
Name of Veterinarian:
Address:
Phone:
What type of building do you live in (ie. house, apartment, etc.)?
Do you Rent _____ Own _____
If you rent does your landlord know that you plan to adopt a dog?
Landlord contact information:
Is your yard fenced? Size of fenced yard:
Describe fence (ie. height, material, etc.):
Where will the pet be housed?
Indoors ___ Outdoors ___ Fenced Yard ___ Tied ___
Other (please explain):
Does everyone in your household agree with adopting a dog?
Is any household member allergic to dogs?
Is any household member afraid of dogs?
Does any household member smoke?
Do you have children? Number _____ Ages _____________
How much contact with the children will the dog have?
How would you describe your child(ren's) behavior around animals?
Have you owned pets before?
What happened to those pets?
Describe any other pets you may have:
Are they spayed/neutered? Do you support spaying and neutering?
What activities do you plan on participating in with your dog?
What do you know about the breed you have chosen?
Why do you want to adopt "this" dog?
Please name at least 2 non-related personal references who do not share your premises that we may contact:
Name: Relationship:
Phone/Email:
Name: Relationship:
Phone/Email:
Name: Relationship:
Phone/Email:
RELEASE OF LIABILITY AND INDEMNIFICATION
I/WE,
(Name, address and telephone number): _____________________________________
_______________________________________________________________________
HEREBY AGREE TO THE FOLLOWING:
- TO care for this dog humanely (including providing adequate food, water, shelter, love, attention, exercise and boundaries). Said dog shall be maintained in an adequate enclosed area or on a leash at all times. Dog shall not be allowed to roam at will. (initial) ____________
- THIS dog will not be isolated for long periods. It shall not be chained or tied at all, nor confined for other than short periods as occasionally necessary to a pen, run, or other enclosure. (initial)______________.
- THIS dog shall never be used as guard dog. All dogs will loyally warn and defend, but it’s not their primary purpose, which purpose is to be loved, respected, and included in its family circle. (initial)_____
- TO give reasonable protection of this dog from the uneducated behaviour of children and adults, and conversely, of children and adults from this dog. I understand and acknowledge that this dog has been tested for dog/cat/people aggression and I understand the extent (if any) of this aggression. I/We will be sensitive and diligent regarding the safety of other animals and people and I/We will assume all risks associated with this assessment. (initial) ____________
THIS dog shall not be euthanized for reasons of behaviour. (initial)_______________.
THE adoption fee of _________________ DOLLARS will not be refunded after 10 days from the adoption date. I/We also agree that the Creston Pet Adoption and Welfare Society will keep 25% of the adoption fee, if the dog is returned within the 10-day period. (initial) ____________
THAT the said dog shall not be used for medical or any other experimental purposes or sold or given to a pet store, supplier or wholesaler. (initial) ____________
THAT we will notify the Creston Pet Adoption and Welfare Society within 10 days of any change of address or phone number. (initial) ____________
IT is also understood that the Creston Pet Adoption and Welfare Society cannot be held responsible for any health or temperament problems that may develop following the adoption of said dog. (initial) ____________
IT is further understood that the Creston Pet Adoption and Welfare Society may examine and make inquiries about said dog at any time. If not satisfied with the condition of the dog or the conditions in which it is kept, said dog can or may be removed immediately and placed in a different home. Any veterinary services needed due to negligence or lack of care will be the responsibility of the adopter and payable to the Creston Pet Adoption and Welfare Society. (initial _______)
THIS dog shall not be transferred to any other person without written permission of the Creston Pet Adoption and Welfare Society. (We may very well approve of a new family if you must give up your dog for any reasons, but we must screen them just as we screened you, and the new family must sign our adoption agreement.) I/We will immediately provide Creston Pet Adoption and Welfare Society with the new name/location/address. (INITIAL)_________
I/We promise and agree to be solely responsible for this animal, and to indemnify and hold harmless the Creston Pet Adoption and Welfare Society from any and all claims of liability for the conduct of this animal on or after the date of this adoption.
This Release of Liability and Indemnification shall apply to all known, unknown and anticipated damages resulting from my/our adoption, ownership and control of this the said dog.
I/WE HEREBY ACKNOWLEDGE that I/We have read and understand the above terms and conditions and will keep the dog described herein as a family member, with all the rights and privileges attached.
SIGNED: Creston Pet Adoption and Welfare Society:
____________________________________ Per: ________________________________
____________________________________ Per: ________________________________
