FORM - Seniors for Seniors Adoption - Amy's Adoptables

Name

First Last

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email

Past dogs you have owned. How long? Where are they now?

Do you have a fenced in yard?

Yes
No

Did/Do you treat your dog(s) with flea/heart worm preventative?

Yes
No

Where in your home is your dog welcome? Will you confine them?

Have you kept up-to-date on all vaccinations with past and current pets?

Yes
No

If for ANY reason you cannot keep this dog, is is to be returned to 911 Rescue. Please initial here to show you understand and agree to this term of adoption

What is your mobility level? Are you able to walk your dog daily?

Do you have any major medical problems that would prohibit you from properly taking care of a dog?

Do you have someone to care for your dog if you are temporarily away?

Yes
No

Have you ever surrendered an animal? If so, Why?

If you have any children or grandchildren in your home, what are their ages and what experience have they had with animals? It is very important to involve your child(ren) in the training of your dog

Veterinarian's Name

Veterinarian's Phone

Veterinarian's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please provide the name, relation and phone number of three personal references.

Terms and Conditions*

I agree to the terms and conditions.

911 Dog Rescue Inc. relinquishes any and all responsibility of said dog once you take the dog into your possession.
This includes but is not limited to furniture, home interiors, etc., or any behavioral issues.

911 Dog Rescue Inc. reserves the right to perform a home check before an adoption is finalized and also at any time after the adoption is finalized. 24 hours notice will be given before a home check after a finalized adoption.

If the pre-adoption home check is not up to par per Amy Beam, 911 Dog Rescue Inc. reserves the right to deny the adopters until the issues are resolved or deny them indefinitely. If a home check is performed after the adoption is finalized, Amy Beam will review any issues and the dog may be removed from the adopters if the dog is in danger. At that time, the dog will not be returned to the adopters and the adoption fee will not be refunded.

By signing, you promise to be a responsible pet owner by feeding and watering, flea treating and caring for your dog as it is going to be a part of your family.

Upon final adoption, you MUST have a county dog license and a SECURE name tag with your current home address and phone number.

All 911 Dog Rescue Inc. dogs have a Health Certificate and have been tested and are heartworm negative, rabies vaccinated (if proper age) and are up to date with shots. You will receive records upon final adoption. I do everything in my power to ensure the health of these dogs but I am NOT a vet and I cannot guarantee health.

For your protection, 911 Dog Rescue Inc. encourages a vet appointment be made with your vet within a two week period AFTER final adoption and IMMEDIATELY be put on heartworm preventative.

All money received from donations goes directly back into the rescue to pay for dog food, vetting, shots, spays/neuters, dog toys, treats, and anything else the pups may need.

We are grateful to all those who support this effort.

Type your name to represent signature

Date

Adopt a Senior Dog Form