Pet Adoption Application - Giles Animal Rescue

Please complete the entire application, and check each item at the end to indicate that you have read it.

If you would prefer a downloadable PDF application please, click here. Completion of this application does not guarantee adoption of a foster animal in the care of Giles Animal Rescue, Inc.

In order to be considered as an adopter you must (check all):

Be at least 18 years of age and have a valid driver’s license or ID with your current address.
Have the knowledge and consent of your landlord if renting.
Understand that if you can no longer care for the pet, you will return it to Giles Animal Rescue volunteers.
Understand that you will need to provide proper food, shelter, training, exercise and veterinary care for the life of this animal.

Your name:

Your email:

Phone:

Your date of birth:

Street Address:

City:

State:

Zip Code:

Number of Adults in Household:

Number of Children in Household:

Ages of Children:

Are all the adults in your household in agreement about your adopting a dog or cat?

YesNo

List other Adults living in household and Date of Birth:

Who will be the primary caregiver for your new dog or cat?

Is any member of the household allergic to dogs or cats?

YesNo

What type of housing do you live in?

HouseApartmentCondoMobile HomeDuplex

Do you own or rent?

OwnRent

Do you have a fenced yard?

YesNo

If renting, please provide Name of Landlord:
Landlord Phone:
Landlord Street Address:
Landlord City, State, Zip Code:

Why do you want a dog or cat?

What qualities are you looking for in a dog or cat?

Which of the following dog or cat behaviors would be a serious problem for you?

not good being left alonedifficult to walk on a leashexcessive barkingsheddingnot getting along with catsnot playful with childrenscratching furnituretoo activenot playful with other animalsnot using a litter boxnot house-traineddiggingnot getting along with other dogsnot getting along with familyjumping a fence

Other behaviors:

How many hours each day will the dog or cat be left alone?

Where will the cat or dog be kept when left alone?

Where will the dog or cat be when you are home?

Where will the dog or cat sleep at night?

Are there times when the dog will be tied outside?

YesNo

If yes, when?

How often and what type of exercise will you give your dog?

Name & description of dog or cat you are interested in?

Will this be your first dog or cat?

YesNo

If you currently have a companion animal(s), please complete:

How many cat(s)?
Age of cat(s)?
Gender of cat(s)?
Spay/neutered? YesNo

How many dog(s)?
Age of dog(s)?
Gender of dog(s)?
Spay/neutered? YesNo

Are all of your pets up to date on vaccinations?

YesNo

Date of last vaccinations:

If you previously owned a companion animal(s),please let us know the type of pet, age, how long you had them, and why you no longer have the animal.

Name of your current veterinarian:
Current vet Phone:
Current vet Street Address:
Current vet City, State, Zip Code:

Name of your previous veterinarian:
Previous vet Phone:
Previous vet Street Address:
Previous vet City, State, Zip Code:

Do you have any objection to our contacting this vet?

YesNo

Have you ever turned a pet into a shelter?

YesNo

If yes, explain:

Are you planning to attend obedience classes with your new dog?

YesNoI am comfortable training my new pet

If your new dog is not housebroken, how will you correct him/her when there is an accident, and what method will you use to train him/her?

How long do you expect house training to take?

When you go on vacation/travel, who will care for the dog or cat?

Are you willing & able to pay for annual vaccinations, required rabies tags, county animal tag?

YesNo

Do you agree not to have a cat declawed or not to dock/clip dog’s tail or ears?

YesNo

Are you willing & able to pay for heartworm prevention and flea/tick prevention?

YesNo

How much do you estimate all routine veterinary care will cost each year?

How much do you estimate will be the annual cost of dog or cat food and treats?

Are you ready to take responsibility for this dog/puppy for the next 10-15 years?

YesNo

Are you willing to have a representative of Giles Animal Rescue visit where the dog or cat will be living?

YesNo

Please provide the name, address, and phone of three references who are familiar with you and your relationship with your animals.

Reference #1 Name:
Reference #1 Phone:
Reference #1 Street Address:
Reference #1 City, State, Zip Code:

Reference #2 Name:
Reference #2 Phone:
Reference #2 Street Address:
Reference #2 City, State, Zip Code:

Reference #3 Name:
Reference #3 Phone:
Reference #3 Street Address:
Reference #3 City, State, Zip Code:

I have read and agree to the following terms of adoption:

The animal will receive proper food and water, shelter, and loving humane treatment by myself and other family members, and will not be left alone for extended periods of time (more than an average work day).
The animal will be kept indoors (cat) or in a sheltered kennel (dog), and not allowed to run unsupervised in an outdoor environment.
If animal is tied outside, the tie must be no shorter than twenty (20) feet, and the area must be adequately sheltered against environmental conditions. The tie must be free of obstacles around which the animal could entangle itself.
I understand that Giles Animal Rescue, Inc. has little or no knowledge of the animal, including its medical condition or background or behavioral disposition and makes no warranties with regard to the health of the animal and disclaims any liability for any current or future medical condition, sickness or disease. Any known health conditions will be disclosed to me while adoption is pending.
When I assume ownership, the animal will receive annual vaccinations according to a veterinary schedule, and will be treated immediately for any illnesses or injuries that may occur.
The animal will not be subject to harassment by myself or other persons who live or visit my home, and will be protected from other animals in my care. Additionally, the animal will not be used for purposes of experimentation, vivisection, or for breeding.
I will not sell or give away this animal to anyone. It will be returned to Giles Animal Rescue, Inc. if I no longer want this pet.
I understand that if I knowingly fail to comply with the above terms, or in any way put the animal in a situation which endangers it’s health, Giles Animal Rescue, Inc. may take appropriate action, including removing the pet from my possession and/or legal action against me.
If, at any time, I am unable to care for the animal according to the conditions stated above, I will allow Giles Animal Rescue, Inc. to resume ownership of the animal.
I release Giles Animal Rescue, Inc, its Board of Directors, volunteers, foster homes and representatives, and the veterinarian treating the animal at the request of Giles Animal Rescue, Inc. from any and all claims and actions, whether for property damage caused by the animal(s), for personal injury to me, family members and other animals in my care (personal pets or livestock) from biting, scratching, transmittal of disease, and/or any other matter attributable to said animal(s).
I agree to pay the pre-determined adoption fee. I understand this is to help defray the costs for veterinary care provided such as spay/neuter/vaccinations/deworming/heartworm & Lyme Disease test and preventive medication/feline leukemia test and/or vaccinations, flea and tick treatment if needed or any other necessary or routine care costs prior to taking ownership of this animal. All charges will be discussed with me while adoption application is pending.

Digital Signature:
I certify that the information above is true and understand that false information will result in nullification of this adoption.

Today's Date:

Please complete the entire application, and check each item at the end to indicate that you have read it.

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