RRAR Dog Adoption Form Name of Adopter * First Name Last Name Name of Pet you wish to adopt: * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Age * Driver License State * Driver License Number * Employer * Number Of Years at Job * Reference 1 Name * First Name Last Name Reference 1 Phone * (###) ### #### Reference 1 Relationship * Reference 1 Years Known * Reference 2 Name * First Name Last Name Reference 2 Phone * (###) ### #### Reference 2 Relationship * Reference 2 Years Known * Do you Live in a: * House Townhouse Apartment Condo Other If other please specify: Your home is: * Owned, by you or your spouse/life partner Owned by someone else within the house Rented directly from the owner or through a management company Rented as a part of a group of roommates. Other: If other please specify: If renting, is your name on the lease? Yes No N/A If renting do you have the landlord permission to have a dog? Yes No N/A Who Shares your home? * Are there children in the home? Yes No If Yes How many children? Age(s)? If there are children, what experience do they have around dogs? Do you plan to move soon? Yes No Is your yard fenced in? Yes No If not, how do you intend on exercising your newly adopted dog? If your current relationship/living situation were to change and you were no longer able to care for the pet, a new application must be submitted and approved to transfer ownership. Please type your name to indicate you understand * First Name Last Name Do you currently have any pets? * Yes No If Yes, how many? Type of pet: Dog Cat Other N/A Pet's Name Breed/if other species please specify: Age Temperament? Anything else we should know about this pet? Are they up to date of their Vaccinations? Yes No Are they spayed/neutered? Yes No Type of pet: Dog Cat Other N/A Pet's Name Breed/if other species please specify: Age Temperament? Anything else we should know about this pet? Are they up to date of their Vaccinations? Yes No Are they spayed/neutered? Yes No Type of pet: Dog Cat Other N/A Pet's Name Breed/if other species please specify: Age Temperament? Anything else we should know about this pet? Are they up to date of their Vaccinations? Yes No Are they spayed/neutered? Yes No Type of pet: Dog Cat Other N/A Pet's Name Breed/if other species please specify: Age Temperament? Anything else we should know about this pet? Are they up to date of their Vaccinations? Yes No Are they spayed/neutered? Yes No Who is your veterinarian? * Name of the Clinic: * Veterinarian Phone Number (###) ### #### RRAR Does NOT approve chaining a dog or leaving them outside without adequate food, water or shelter. “Yard Abandoning” a dog adopted through RRAR would be a breech of contract and legal action will be taken. Please Type Initials that you understand. * Why have you chosen to adopt a Dog? * Where will your dog new dog be kept? * Indoors Indoor/Outdoor Outdoors Percentage of time Indoors: Percentage of time Outdoors: Have you had experience or behavioral knowledge of the dog breed you have chosen to adopt? * Yes No Do you understand that the average life span of a dog is 15 years and that you will be physically, emotionally and financially responsible for the dog throughout its life? * Yes No Do you understand that dogs need copious amounts of attention and will require daily exercise and training to keep their mental and physical health optimal? * Yes No Do you understand that in general, dogs take AT LEAST two (2) weeks, sometimes longer, to adjust to a new home and/or other pets and people. Will your new dog get the time and space he or she needs to make the adjustment? * Yes No Which of the following reasons might force you to give up your dog? (Check all that apply): * No reasons Behavioral Issues Marking, urinating, deficating in the home? Financial Issues Not getting along with other pets Other reasons: Other reasons you might give up a pet: Have you ever abandoned or given up a pet? * Yes No If so, what were the circumstances? HOME CHECK: Prior to your dog adoption you will be required to agree to a home check. A home check will be performed either in person or via video chat at which time an RRAR adoption specialist will ask a few questions and request to see specific areas of your home. This check is done solely for the purpose of ensuring the safety of the adopted pet. * Yes No ADOPTION DONATION: Prior to your dog adoption you will be required to make an adoption donation of no less than $150. This donation is NON-REFUNDABLE and can be paid via Cash, Check or PayPal. Please note: All pets adopted through RRAR have been vetted through Goodwin Animal Hospital, Pike Road and given a clean bill of health. If they are adult animals they have been fully vaccinated, spayed or neutered, treated for internal parasites, been given heartworm/flea treatment and microchipped. If they are juvenile animals they have been given their first round of vaccinations, treated for internal parasites, been given heartworm/flea treatment and microchipped. Due to being under age, the spay or neuter procedure will be completed at time of sexual maturity and the final vaccination administration will be done. No additional donations required, but they are ALWAYS greatly appreciated. * Yes No Liability Section I acknowledge that, due to the unpredictable nature of animals, certain risks and dangers may occur while caring for an animal, including risks of injury to person and property, and that I have voluntarily agreed to make the adoption with full knowledge of such risks and herby voluntarily assume all of such risks. * Agree I agree that I will make no claims against or attach any property of RRAR directors, officers, agents, employees, and/or volunteers, including without limitation, for any injury or damage caused by any animal(s) adopted from RRAR. * Agree I hereby voluntarily release, discharge, waive, and relinquish any and all actions or causes of action for personal injury, property damage, or wrongful death occurring to me or third parties as a result of any action or activity of any animal(s) adopted by me from RRAR. IT IS MY INTENTION BY THIS INSTRUMENT TO EXEMPT AND RELIEVE RRAR FROM ALL LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE, OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR OTHERWISE. * Agree I HAVE CAREFULLY READ THE FORGOING, AND I UNDERSTAND THAT TOGETHER THEY CONSTITUTE A DISCLAIMER OF LIABILITY BY RRAR AND A RELEASE OF ALL CLAIMS BY ME. I UNDERSTAND THAT I ASSUME ALL RISKS INHERENT IN MY DECISION TO ADOPT AN ANIMAL FROM RRAR. I VOLUNTARILY SIGN BELOW TO EVIDENCE MY ACCEPTANCE OF THE ABOVE PROVISIONS. * Agree Contract Section The dog, is being transferred to the adopting owner with theunderstanding that the adopter is taking possession of the dog to treat, and to be responsible for it, as their own dog. * Agree The dog will be treated as a family member with loving care and affection. I will do my best to ensure the dog’s safety and well-being. * Agree I will feed the dog at least twice a day and will always provide a fresh supply of water. * Agree The dog will live inside my home and will not be isolated from the family. I will walk my dog on a leash or exercise my dog in afenced yard or park. I will never let my dog run loose or roam, keep my dog chained or tied up, keep it continuously in a yard,garage, patio, balcony, or pen, or leave my dog outdoors, even in a fenced yard when no one is at home. * Agree I will not have the dog attack-trained, nor will I use it for any purpose other than companionship. I will not have the dog’s earscropped, nor will I have its tail docked. I will never allow any physical, mental, or emotional abuse of the dog. * Agree I am adopting the dog for myself, and I agree not to give away, sell, or trade my dog, even as a gift, to a friend or familymember. I will neither take the dog to a shelter nor abandon the dog. I understand that I must notify RRAR, without delay, if Ican no longer care for or keep my dog and agree to give RRAR reasonable time to rehome my dog or place my dog in an approved foster home, if possible. * Agree Shot Date MM DD YYYY The dog will be given heartworm-preventative tablets every month, all year long. I will have a heartworm test given everyyear. If there is any break in dispensing heartworm medication, I will retest for heartworm and restart the medication immediately. * Agree The following statement is required by Alabama law: STERILIZATION OF ANY ADOPTED ANIMAL IS REQUIRED BY 2022 Code ofAlabamaTitle 3 - Animals.Chapter 9 - Sterilization of Dogs and Cats. THE ADOPTER AGREES TO ASSUME FULL RESPONSIBILITY FOR COMPLIANCE WITH THE PROVISIONS OF Ala. Code § 3-9-1 WHICH PERTAIN TO THE TIMELY STERILIZATION OF THE ADOPTED PET. A PERSON WHO VIOLATES THIS ARTICLE IS SUBJECT TO CIVIL PENALTY. THE NEW OWNER MAY BE COMPELLED TO COMPLY WITH THE PROVISIONS OF THIS ARTICLE. If not already done, I will have the dog spayed/neutered by 6 months and will immediately forward proof to the RRAR office. Failure to comply with this requirement will result in the immediate return of the dog to RRAR. * Agree I affirm that no member of my household has been convicted of an animal welfare law violation such as neglect, cruelty, abandonment, etc. * Agree I will ensure proper licensing of the dog and will attach the appropriate license tag, rabies tag, and personal identification. * Agree I am adopting the dog for myself, and I agree not to give away, sell, or trade my dog, even as a gift, to a friend or familymember. I will neither take the dog to a shelter nor abandon the dog. I understand that I must notify RRAR, without delay, if Ican no longer care for or keep my dog and agree to give RRAR reasonable time to rehome my dog or place my dog in an approved foster home, if possible. * Agree I must notify RRAR of any behavioral problems that have occurred at any time if I can no longer care for my dog, and I agree to pay for a professional trainer’s evaluation in cases of biting or aggression. I understand that RRAR does not guarantee that they will accept my dog back into the rescue if aggressive behavioral problems exist without being properly addressed. * Agree I agree to accept responsibility and ownership of the dog at my own risk, and I release RRAR and its agents from any and all liability arising out of possession and ownership of my dog. I agree that I am assuming total financial responsibility for my pet as of the date of this contract. RRAR and its agents will not be held responsible for any damages or expenses (veterinary or other) incurred during my ownership of the dog. * Agree In the event the dog becomes lost or dies, I will immediately notify RRAR. I will also immediately notify RRAR of any change of contact information (address, phone number, or email address). * Agree This dog’s known background and medical history have been discussed with me. I understand that RRAR has made no representation concerning the health, condition, training, behavior, or temperament of the dog. * Agree I agree to permit RRAR to make inquiries about and enforce any of the above conditions and requirements at any time within the first year of adoption. This can include visits to my home and contact with my veterinarian. I UNDERSTAND THAT FAILURE TO COMPLY WITH ANY OF THE ABOVE PROVISIONS FOR THE LIFE OF THE DOG WILL RESULT IN THE FORFEITURE OF THE DOG TO RRAR. * Agree I understand that by voluntarily signing this agreement, I am entering into a legal and binding contract with River Region Animal Rescue. Breach of any term(s) of this agreement is deemed actionable by RRAR. In the event there is a violation of the agreement, I agree to pay a minimum of $1,000.00 in damages. Additionally, to facilitate the collection of damages for breach of contract, I waive any challenge to venue and agree that the appropriate venue for this matter is Alabama, and the County of Montgomery. Furthermore, I agree to accept service of process by certified mail, return receipt requested, to the address provided in this adoption contract, and specifically waive any right to receive personal service. * Agree Microchip Number: Signature Section SIGNATURE OF ADOPTION: By signing below I understand and agree that giving false information in response to any questions above will disqualify me from adopting a pet from RRAR and will nullify all agreements between me and RRAR. Typing your name constitutes agreement to the above requirements: * First Name Last Name Signature Date * MM DD YYYY Thank you our adoption team will reach out to you soon!
