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ADOPTABLES
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About Us
Gallery
ADOPTABLES
Amazon WishList!
Dog Paw Raffle
Adopt
Support Us!
Donate
Adoption Application:
Every question must be answered. If it does not apply to you, simply put NA (not applicable).
Name
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First Name
Last Name
Email
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Address
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Phone Number
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Occupation and Employer Contact
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Names of adults living in the home
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Who will be financially responsible for the newly adopted dog?
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How many children in the home and what are their ages?
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Is anyone in the household allergic to dogs?
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Do you rent or own your home?
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If you rent, please supply your landlord's name and phone number.
What type of property is your home? (example: single family, condo, apartment, etc)
*
Do you have a fence?
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Do you have any current pets? If so, please list type of pet and age of pet.
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Are all of your pets spayed or neutered? If not, please explain why.
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Are all of your pets up to date on vaccinations, flea and heartworm preventatives?
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Have you ever surrendered a pet? If yes, please explain.
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Are you interested in a specific dog in our rescue? If so, who?
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What will you do if your newly adopted dog is not getting along with your current pets?
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On a typical day, how long will the new dog be left unattended?
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Where will they be kept?
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Where will they sleep at night?
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Please list your veterinarian's name and contact information:
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Please list 3 personal references
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Is there anything else you'd like us to know?
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Where did you hear about us?
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This dog (s) will reside in my home as a pet. I will provide it with quality dog food, plenty of fresh water, indoor shelter, affection, annual physical examination and vaccinations under the supervision of a licensed Veterinarian. If I am adopting an animal that is too young for alter, I attest that I will provide Bella’s Tail Waggin’ Rescue with a spay or neuter certification, from my veterinarian when the animal is of twenty weeks of age. By signing I attest that all of the information I have given is true and complete to the best of my knowledge. I also understand there is an adoption fee to help cover vetting expenses that are given prior to adoption. I understand that the animals that are up for adoption are from animal shelters and full knowledge of the animal may not be known. I acknowledge that Bella's Tail Waggin’ Rescue has informed me, to the best of their knowledge, about the animal being adopted and I will not hold Bella’s Tail Waggin’ Rescue owner or directors liable for any damage caused from the animal I am adopting. I hereby waive, release, and discharge any and all claims and damages for personal injury, death, or property damage which I may sustain or may which hereafter accrue as a result of my participation in adopting a rescue animal. This release is intended to discharge in advance Bella’s Tail Waggin; Rescue, its’ Directors, Officers, and/or agents to include their heirs, agents, representatives, successors and assignees from and against any and all liabilities, actions, claims, demands, costs, or expenses arising from or in any way I understand that various activities involving dogs and/or puppies can be hazardous in nature involving the possibility of being bitten, scratched, jumped on, dragged or nocked over. The possibility of serious accidents and/or injury can occur. Knowing the risks involved nevertheless I have voluntarily applied to adopt a rescue animal and I hereby agree to assume all risks of injury, and to release and hold harmless Bella’s Tail Waggin’ Rescue its ’Directors, Officers, and/or agents who through negligence or carelessness might otherwise beliable to me. I further agree to indemnify and to hold Bella’s Tail Waggin’ Rescue, its’ Directors, Officers, and/or agents free and harmless from any loss, liability, damage, cost or expense which they may incur as a result of any injury and/or property damage I may sustain from the adoption of a rescue animal. I hereby grant Bella’s Tail Waggin’ Rescue permission to use my likeness in a photograph/video or any photo/video that I upload to the Bella’s Tail Waggin’ Rescue Facebook page or designated repository (e.g. Flickr) in any and all of its advertising or collateral materials, including the Bella’s Tail Waggin’ Rescue website without payment or any other consideration. I hereby irrevocably authorize Bella’s Tail Waggin’ Rescue to edit, alter, copy, exhibit, publish or distribute any photos/videos taken of or by me for purposes of publicizing Bella’s Tail Waggin’ Rescue organization or for any other lawful purpose.I HAVE CAREFULLY READ THIS WAIVER OF LIABILITY, MEDICAL RELEASE ,PHOTO/VIDEO RELEASE AND INDEMNIFICATION AGREEMENT AND FULLYUNDERSTAND THE CONTENTS. I AM AWARE THAT THIS IS A RELEASE OFLIABILITY AND AGREEMENT BETWEEN MYSELF (AND MY GUARDIAN, if applicable)AND BELLA’S TAIL WAGGIN’ RESCUE. By typing your name below, you agree to the terms stated above. *
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Thank you!
