CRESTON PET ADOPTION AND WELFARE SOCIETY

P. O. Box 253 Creston BC V0B 1G0

250-428-7297 ~ paws@kootenay.com

Website ~ www.crestonbc.com/paws/

DOG ADOPTION APPLICATION

This application does not guarantee that you will be granted the right to adopt.

PART A - DESCRIPTION OF PET

Paws Tag No. _________________ Microchip 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(s): ____________________________________________________________________________

Residential Address: ______________________________________________________________________

Mailing Address: _________________________________________________________________________

Phone - Home: _______________________________ Work: _____________________________________

Email Address: __________________________________________

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? ___________________________________________________________

What do you know about Crating? How, and under what circumstances, would you use crating with this dog?

_______________________________________________________________________________________

If you believed disciplinary action was needed to correct a behaviour, what action would you take?

_______________________________________________________________________________________

If your living arrangements were to change (i.e. moving, family) what would your plans be for 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, ______________________________________________________________________________

HEREBY AGREE TO THE FOLLOWING:

1. TO care for this dog humanely (including providing adequate food, water, shelter, love and attention). This dog shall be maintained in an adequate enclosed area or on leash at all times. Dog shall not be allowed to roam at will.

(initial)________________.

2. THIS dog will not be isolated. It shall not be chained or tied, nor confined to a pen, run, or other enclosure, except for short periods for the dog’s safety if necessary.

(initial)______________.

3. THIS dog shall never be used as guard dog. All dogs will loyally warn and defend, but it is not their primary purpose, which purpose is to be loved, respected, and included in its family circle.

(initial)__________

4. 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 assessed to the best ability of the foster parent and its temperament has been reported in truth and if categorized as dog/cat aggressive I will be sensitive and diligent regarding the safety of other animals and people and that I will assume all risks associated with this assessment.

(initial)_______________

5. TO vaccinate annually with necessary inoculations (DHLP-P) including full set of puppy shots if required and to vaccinate against Rabies, as local ordinances require.

(initial)_________________

6. TO provide necessary and essential veterinary care, as required.

(initial)____________

7. TO notify the Creston Pet Adoption and Welfare Society if said dog becomes lost or stolen.

(initial)____________________

8. TO have this dog spayed/neutered within 4 months of adoption if not already done (i.e. dog was too young to spay/neuter when adopted). A copy of sterility certificate must be sent to PAWS.

(initial)_______________

9. IF this dog is recognized as an abused animal I will be sensitive and understanding to the special needs and concerns associated with any related behaviour and will work towards the betterment of life for this dog, including providing appropriate supervision, training and socialization.

(initial)_____________________

  1.  
  2. NOT to sell, trade or dispose of this dog. If, at any time, I/We are unable OR unwilling to care for this dog, I/We agree to contact and return said dog to Creston Pet Adoption and Welfare Society. (initial)___________________
  3.  
  4. This dog shall not be euthanized without Creston Pet Adoption and Welfare Society permission, except under extraordinary circumstances.
  5. (initial) _______
  6. This dog shall not be euthanized for reasons of behaviour.
  7. (initial)_______________.
  8. 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.
  9. (initial)___________________
  10. THAT this dog shall not be used for medical or any other experimental purposes or sold or given to a pet store, supplier or wholesaler.
  11. (initial)_______________
  12. THAT this dog will not be used for any illegal purposes and will NEVER be pitted or game tested in any way. If this clause is broken, I/We understand that the dog will be immediately confiscated by the Creston Pet Adoption and Welfare Society and all law enforcement agencies will be notified, as applicable. I/We certify that we do not live in any area where "Pit Bulls" are banned. (If the dog being adopted is a Pit Bull or Pit cross.)
  13. (initial)_________________
  14. THAT we will notify the Creston Pet Adoption and Welfare Society within 10 days of any change of address or phone number.
  15. (initial)___________________
  16. 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 this dog. (initial)______________________
  17.  
  18. IT is understood that a PAWS Director may make periodical visits to ascertain that the Adopted Dog is receiving the care and attention it requires.
  19. (initial) ___________________________
  20. IT is further understood that the Creston Pet Adoption and Welfare Society may examine and make inquiries about this dog at any time if it has been reported to us that the dog in question is being abused or neglected. In the event that any part of the contract agreed to and signed by the Adopter is breached we reserve the right to repossess the dog. If not satisfied with the condition of the dog or the conditions in which it is kept, the dog may be, or can 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.
  21. (initial)_________________
  22. If the Potential Adopter is under the legal age of Eighteen (18) years of age this application must be signed by a legal Guardian. The Guardian assumes full responsibility for the Adopted Dog.

(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 dog 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 dog.

I/WE consent to the information contained in this document being used within the PAWS organization or other legitimate rescue groups only.

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.

I/WE understand a PAWS Director may visit periodically to insure the dog is receiving proper care.

 

SIGNED: _____________________________________ DATE: _________________________________

_____________________________________

 

Creston Pet Adoption and Welfare Society:

Home Check date: ____________________ Conducted by: ___________________________________

Reference Checks date: ________________ Conducted by: ___________________________________

Per: _________________________________________ Position: ________________________________

Per: _________________________________________ Position:_________________________________

Approved date: _______________________________