First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County*

Email*

Home Phone

Work Phone
x

Cell Phone*

Today's Date:*

Adopter's Date of Birth:*

Drivers License Number:*

State of Drivers License:*
Choose one: AL Alabama AK Alaska AZ Arizona AR Arkansas CA California CO Colorado CT Connecticut DE Delaware DC District of Columbia FL Florida GA Georgia HI Hawaii ID Idaho IL Illinois IN Indiana IA Iowa KS Kansas KY Kentucky LA Louisiana ME Maine MD Maryland MA Massachusetts MI Michigan MN Minnesota MS Mississippi MO Missouri MT Montana NE Nebraska NV Nevada NH New Hampshire NJ New Jersey NM New Mexico NY New York NC North Carolina ND North Dakota OH Ohio OK Oklahoma OR Oregon PA Pennsylvania RI Rhode Island SC South Carolina SD South Dakota TN Tennessee TX Texas UT Utah VT Vermont VA Virginia WA Washington WV West Virginia WI isconsin WY Wyoming

Does EVERY member in the home know and agree with the adoption of this animal?*
Choose one: Yes No

What is the Name of the Animal being applied for?*
Choose an animal: FOSTER

Why do you want to adopt this animal? Check all that apply:

Do you presently own any pets?*
Choose one: Yes No

If you do currently own pets, how many and what kind?

If you currently own pets, are they up to date on vaccines?
Choose one: Yes No

If you currently own pets, are they all Spayed and/or Neutered?
Choose one: Yes No

If you currently own pets, do you have them on Heartworm and Flea/Tick preventative medication?
Choose one: Yes No

If you have other pets, what brand of heartworm preventative do you use?

If you have other pets, what brand of flea and tick preventative do you use?

Are you able to provide proof of current vaccines and heartworm / flea & tick preventative at the time of adoption?
Choose one: Yes No

If you currently own pets, please provide the Name, Address and Telephone Number for your current Veterinarian Office.

Which do you live in?*
Choose one: House Mobile Home Apartment Condo

Do you own your home?*
Choose one: Yes No

If you rent your home, does your landlord allow pets and have you notified them of your intent to adopt?
Choose one: Yes No

If you are renting, what is the phone # to reach your landlord?

Are there children presently living in the home?*
Choose one: Yes No

If there are children in the home, what are their ages?

Do you have a fenced in yard?*
Choose one: Yes No

If you do have a fenced in yard, what type of fence?

If you do have a fence, how high is it?

Have you ever surrendered or rehomed a pet before?*
Choose one: Yes No

If you have surrendered or rehomed a pet, please describe the situation.

How do you plan to provide for your pet if you are out of town?*

What would you do with your pet if you were forced to move?*

Are you prepared for veterinary expenses such as emergency medical problems (especially in old age) that can be quite costly, and that can be incurred at any time during the entire life of this pet?*
Choose one: Yes No

Are you willing to live with a pet that can be destructive at times?*
Choose one: Yes No

Which of the following reasons would prompt you to give up your pet?

Where will you keep this pet when you are not home?*

How long (in hours) will the pet be left alone per day?*

Where will the pet spend the majority of its time?*

Where will the pet's sleeping quarters be?*

How would you rate your pet experience?*
Choose one: 1st Time Pet Owner Beginner Intermediate Dog Trainer

Do you plan on enrolling your new pet in obedience training classes?*
Choose one: Yes No

Do you plan on Crate/Kennel training your new pet?*
Choose one: Yes No

If you are not planning on kennel training, please tell us why?

What is your current occupation?*

What is your current annual income?*

What is your Place of Employment? Please include Business Name, Address and Phone #*

Please provide 2 personal references. Include a phone number where they can be reached.*

This application is not a guarantee for adoption of the pet. Applications for each animal will be reviewed and the pet will be placed in the best forever home based on the pet's needs. Camp Chaos Puppy Rescue reserves the right to refuse adoption to any applicant for any reason. You must be 21 years old to adopt an animal from Camp Chaos Puppy Rescue. I certify that all information on this application is true and correct. I understand that the adoption donation is Non-refundable. Please Sign and Date Below:*

I hereby agree to care for the pet listed on my application in a humane and responsible manner and to provide it with clean and adequate shelter, food, water and veterinary care. I further agree that said pet shall reside inside my home and shall not be allowed to roam freely, nor will this animal ever be kept on a chain. I understand that hitting my dog to correct it is NOT an acceptable form of training or punishment. Initials:*

I hereby agree that this pet will wear a collar and ID tags at all times. The dog has been micro-chipped by the rescue and no attempt shall be made by the adopter to transfer the microchip to another party, or alter the chip in any manner. The rescue will always be the 1st contact listed on the microchip. Camp Chaos Puppy Rescue will add your information as a secondary contact on the microchip. Any attempt to transfer or alter the microchip will be an immediate breach of contract. Initials:*

I hereby agree to notify Camp Chaos Puppy Rescue within 3 weeks if I change my address or telephone number. Initials:*

The animal being applied for has been examined by Camp Chaos Puppy Rescue and a veterinarian prior to adoption and has received immunizations appropriate for its age. I agree to make an appointment for this animal within 3 weeks of adoption for a visit with my vet. It is likely (especially if adopting a puppy) that the adopted animal will need future vaccinations, and I understand that I am solely responsible for that financial responsibility. I also understand that Camp Chaos Puppy Rescue does not hold representations or warranties regarding the animal's health, physical condition, or age after the date on the adoption contract. I understand that health problems may arise with this animal; including serious illnesses requiring emergency care or surgery, and that it is my sole responsibility to seek veterinarian care in a timely manner and to pay any related costs. Initials:*

I hereby agree that if I am adopting an animal that has not yet been spayed or neutered, I understand that it is a MANDATORY procedure. Camp Chaos Puppy Rescue will pay for the cost of the procedure at their approved veterinarian office. I agree that I will make an appointment to have this animal altered within 30 days of adoption. I will provide Camp Chaos Puppy Rescue with the necessary documented proof of the procedure. Initials:*

I hereby agree that the adopted animal shall not be subjected to any form of cosmetic surgery or alteration including, but not limited to, ear cropping, tail docking, dew claws, removal of rescue microchip etc., unless deemed medically necessary by a veterinarian. Such procedures are extremely painful and typically not necessary. Initials:*

In accordance with the recommendations of The American Heartworm Society, I the adopter agree to keep the adopted dog on heartworm preventative year round. Initials:*

I hereby agree, that if adopting a puppy under the age of 4 months, it shall not be taken to any public place including, but not limited to pet stores, parks, other homes, etc. Puppies are susceptible to many illnesses and disease. I agree to treat my new pet as I would a human infant and to avoid unnecessary sickness and/or death. I agree to make sure the puppy receives all appropriate vaccinations to help prevent such disease. Initials:*

I hereby agree, if I currently own other pets, I will provide proof of current vaccinations and heartworm / flea & tick preventative within 3 days of adoption. If not provided, I agree, my adoption fee will be forfeited and the adopted animal will be reclaimed by a Camp Chaos representative. Initials:*

I hereby agree that Camp Chaos Puppy Rescue makes no warranties or statements regarding the dog's breed, lineage, history, health or temperament. It is agreed and understood by the adopter that while every effort is made to provide accurate history and assessment of a dog, Camp Chaos Puppy Rescue does not warrant a dog regarding medical status, breed, behavior or disposition. It is further agreed that environmental changes may affect and change the temperament of the above named dog and that Camp Chaos has no liability or responsibility of any nature regarding but not limited to future behavioral issues, breed restrictions, or other similar disputes regarding such. Initials:*

I hereby certify that I have never been charged or convicted of animal abuse or neglect. Initials:*

I hereby agree that Camp Chaos Puppy Rescue or any authorized individual acting on its behalf may examine or make inquiry about the adopted pet at any time, with or without notice. If said examination or inquiry demonstrates that the dog is not being cared for in a manner wholly consistent with the above representations and/or the representations made by myself on the Application, I agree that Camp Chaos Puppy Rescue, or any authorized individual acting on its behalf, may reclaim the dog and place it in another home without payment or compensation. If contact is made via phone, I agree to make a good faith effort to return Camp Chaos Puppy Rescue's call as soon as possible. Initials:*

I understand that the adoption donation is NON-REFUNDABLE. Initials:*

I hereby agree that I will keep the pet for as long as it shall live and will not transfer the ownership or custody of the pet to any other person or to any business or organization other than Camp Chaos Puppy Rescue except for the purposes of veterinary treatment and/or temporary lodging of the animal. If I can no longer keep the animal, I will notify Camp Chaos Puppy Rescue IMMEDIATELY and will work with them to place the animal in an approved home. I understand the adoption fee will not be refunded. Initials:*

I understand in the event of any dispute relating to ownership or possession of the animal that is subject to this agreement, the parties agree that the dog shall be placed in the care and custody of Camp Chaos Puppy Rescue until a determination by a court of competent jurisdiction. By execution of this agreement I hereby expressly consent to the removal of the dog by law enforcement from the adopter and placement of the dog with Camp Chaos Puppy Rescue. In the event of a dispute arising out of the terms and conditions of this Adoption Contract, and in the event that Camp Chaos prevails in any legal proceedings initiated as a result of said dispute, I agree to reimburse Camp Chaos Puppy Rescue for its reasonable attorney's fees and expenses incurred as a result of the dispute. Initials:*

I understand that Camp Chaos Puppy Rescue is not making any representations or warranties about the animal's temperament or behavior. I acknowledge and agree that Camp Chaos Puppy Rescue is not responsible for any injury, damage, or harm caused by this animal, and I hereby release Camp Chaos Puppy Rescue from any and all liability for any injury, damage, harm, expense, or liability I incur relating to this animal. I also agree to indemnify Camp Chaos Puppy Rescue from any and all such claims and to pay, without limitation, any costs related to such injury, damage, or liability, including, in the case of litigation, any attorneys' fees incurred by Camp Chaos Puppy Rescue in their defense. Initials:*

I understand that by voluntarily signing this agreement, I am entering into a legal and binding contract with Camp Chaos Puppy Rescue. Breach of any term(s) of this agreement is deemed actionable by Camp Chaos Puppy Rescue. I have read the entire contract carefully before signing it. I agree and understand that this Contract sets forth all promises, agreements, conditions, and understandings between myself and Camp Chaos Puppy Rescue, oral or written and that both parties have fully read and understand the entire Contract. Initials:*

Applicant Signature and Date:*