Applicant Information

Note: This application serves as a contract, so please read carefully. If you would like this Contract emailed to you as a separate file, please let us know. Keep a copy of this application for your own important file.

Applicant Name

First Name

Last Name

Applicant Birthdate

YYYY

Which adoptable are you interested in?

Cell Phone

(###)

###

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Home Phone

(###)

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Home Address

Please note: We are based in NY and will adopt to surrounding NY, NJ, CT and New England areas. Further on a case by case basis. Please note that the adopter must be willing to come to Long Island, NY if approved.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you have a fenced in yard?

Please give details - height, type of fence (chain link, MDF, wood, etc).

Employment Information

Occupation

(if retired, please list previous occupation)

Employer Name

Employer Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Office Phone

(###)

###

####

Co-Applicant Information

If you have a spouse, live with parents, or roommates: please fill out the following information below. If you are over the age of 72: please fill out one Co-Applicant below

Co-Applicant 1

(if applicable)

Co-Applicant 1 Name

First Name

Last Name

Co-Applicant 1 Birthdate

YYYY

Co-Applicant 1 Email

Co-Applicant 1 Occupation

(if retired, list previous occupation)

Co-Applicant 1 Employer

Co-Applicant 1 Relation to You

i.e. spouse, parent, roommate, etc.

Co-Applicant 2

(if applicable)

Co-Applicant 2 Name

First Name

Last Name

Co-Applicant 2 Birthdate

YYYY

Co-Applicant 2 Email

Co-Applicant 2 Phone

(###)

###

####

Co-Applicant 2 Occupation

(if retired, list previous occupation)

Co-Applicant 2 Employer

Co-Applicant 2 Relation to You

i.e. spouse, parent, roommate, etc.

Application Information

Please indicate what you are applying for

Adopt

Foster

Volunteer

Foster with the option to adopt

Have you ever adopted from another rescue?

If so, please include the name of the rescue organization

Vet Information

Please let your Vet know that PRoud Rescuers of PR will be calling and that they are free to speak about your Animals and their veterinary history. If you do not have a current veterinarian, we request that you list your previously used veterinarian. If you do not have a veterinarian, please list a veterinarian you are considering to use if you adopt from PRoud Rescuers of PR.

Veterinarian Name

First Name

Last Name

Veterinarian Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Veterinarian Phone

(###)

###

####

Family Information

List the children living in the household under the age of 18

Please list their names and ages

List the adults living in the household over the age of 18

Please list their names and ages

Pet Information

Present Pets

Please include information such as Animal, Breed, Name, Age, Years owned, where the pet came from, where is the pet now, and what happened to the pet.

Past Pets

Please include information such as Animal, Breed, Name, Age, Years owned, where the pet came from, where is the pet now, and what happened to the pet.

Are your animals up to date on vaccines?

If you have current pets. If pets are not up to date. please explain why.

Are your animals spayed/neutered?

If you have current pets. If pets are spayed/neutered. please explain why.

Please describe how much exercise your new dog would get daily

(i.e. how man walks, dog park, etc)

Do you rent or own your home?

Is the building pet friendly?

How many years have you lived at your current residence?

Do you anticipate moving?

If so, please describe when you anticipate you will move.

Where do you reside?

House

Condo

Apartment

Co-op

RV/Mobile

Assisted living

Whom do you live with?

Live alone

Live with partner

Live with parents or relatives

Live with roommates

(If renting) Landlord/Managing Agent's Name

IMPORTANT: please email your lease showing pet policy in writing. In addition, we require a letter from your landlord on their official letter head stating Pet Policy including details: How many dogs/cats allowed, Any Breed restrictions, Weight restrictions. Both the lease and the letter from your landlord should be emailed to us at PRoudRescuersofPR@gmail.com

First Name

Last Name

(If renting) Landlord/Managing Agent's Phone

(###)

###

####

How many hours a day will this Animal be left alone?

Where exactly will the Animal be kept when alone?

Please state which room you will leave the pet and the type of setup. Please give details.

Who will be primarily responsible for the pet?

How often do you travel?

How many times a year on average

When you travel, will you take your pet with you?

If not, how will you provide for them while you are away?

If you have an emergency while you are away, what will happen to this pet?

If your pet should become injured or ill, what would you do?

What would you do if treatment were expensive?

Have any of your family members, including yourself, had a history of allergies or asthma?

What will you do if the new pet does not get along with present pets?

Have you ever turned an Animal over to a rescue group/shelter?

If yes, please explain in detail.

Please explain in detail why you want to Adopt/Foster/Volunteer

What training methods are you aware of and utilize?

What breed(s) are you looking to foster / adopt and why?

Do you have any breed specific experience, such as temperament, care, grooming, etc?

Describe your ideal Animal companion

Please include personality traits

Please describe the age, sex, breed, weight of the Animal desired

References

Please provide three references, not related to you. Email addresses must be included. Please inform your references that PRoud Rescuers of PR will be in touch. Applications will not be processed if references cannot be contacted.

Reference 1

Reference 1 Name

First Name

Last Name

Reference 1 Email

Reference 1 Phone

(###)

###

####

Reference 1 Relation to You

i.e. friend, co-worker, neighbor, etc

Years you have Known Reference 1

Reference 2

Reference 2 Name

First Name

Last Name

Reference 2 Email

Reference 2 Phone

(###)

###

####

Reference 2 Relation to You

i.e. friend, co-worker, neighbor, etc

Years you have Known Reference 2

Reference 3

Reference 3 Name

First Name

Last Name

Reference 3 Email

Reference 3 Phone

(###)

###

####

Reference 3 Relation to You

i.e. friend, co-worker, neighbor, etc

Years you have Known Reference 3

Emergency Information

If you should become ill, disabled, or if you should die, who will take care of your pet?

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Phone Number

(###)

###

####

Relationship to adopter

i.e. relative, friend, etc

Are there ANY companion Animals current living in this person's household?

If so, please describe the animal's breed, age, sex, and if they are altered.

Legal Contract

Please read and initial all of the following PRoud Rescuers of PR policies and your responsibilities prior to submitting your application.

I understand that if I am unable to care for a pet rescued from PRoud Rescuers of PR I will notify PRoud Rescuers of PR immediately and arrange to return the Animal. I will not give this Animal away to a shelter, rescue, veterinary office, pet shop, friend, research facility, abandon this pet, or give away to any other party without full consent or full agreement from PRoud Rescuers of PR.

Please initial here

I agree to abide by all local Animal ordinances, leases, and property ownership agreements as they pertain to the legally defined number of pets allowed in any human domicile or associated/attached properties. I further agree that, should I be in violation of any local Animal ordinances, leases, and property ownership agreements pertaining to the number of Animals allowed, I hold harmless PRoud Rescuers of PR, and all associated rescue organizations in all matters, and assume all legal and/or financial liabilities pertaining to any violations of said ordinances, leases, and/or agreements

Please initial here

I understand that a home visit must be conducted before this application is approved for foster / adoption.

Please initial here

I agree to allow PRoud Rescuers of PR to conduct a background check & agree to disclose any and all arrests and dispositions of those arrests.

Please initial here

I have read the PRoud Rescuers of PR, Contract and agree to return a signed copy, as requested, should I be accepted as a PRoud Rescuers of PR, foster.

Please initial here

Should my foster pet need vet care, I will notify PRoud Rescuers of PR, immediately. If approved, I will bring the pet to PRoud Rescuers of PR, designated Vet.

Please initial here

I understand that the adoption fee is non-refundable under any circumstances, including if I return the Animal.

Please initial here

The Animal will not be trained, encouraged, nor misrepresented for the purpose of protection, aggression, or any aggravated display of behavior.

Please initial here

I will give the Animal proper grooming, including but not limited to removing hair from ears if applicable, eye and ear care, and regular brushing of teeth, baths, nail clipping and haircuts.

Please initial here

I will provide a humane environment, regular exercise and companionship for my pet. The Animal will have appropriate food, water, indoor shelter at all times, and medical care for the duration of its life. The Animal will be treated as a member of the family.

Please initial here

I will get necessary behavior training and/or expert advice should the Animal require this. Adopter agrees to work with the Animal to modify behaviors as follows: aggression, biting, scratching, barking, mounting, digging, marking, house training without the use of negative reinforcement or other harmful methods. Some behaviors may never be eradicated and PRoud Rescuers of PR, cannot be held accountable for these behavior patterns.

Please initial here

I understand and agree that PRoud Rescuers of PR, makes no express or implied warranty, representation or promise to the age, health, breed, habits, disposition or safety of the Animal. I hereby accept the Animal as is, assume all risks and responsibilities associated with the ownership of the Animal, including bites, and I hereby fully and completely release, indemnify and hold harmless the PRoud Rescuers of PR,, its directors, officers, volunteers, and servants, from any claim, cause of action or liability of any sort or nature, whether known or unknown, directly or indirectly arising out of or in connection with the adoption, care or ownership, maintenance, temperament or condition of the Animal.

Please initial here

If euthanasia becomes necessary, it is agreed the pet will not be turned over to a humane society or Animal shelter for this service PRoud Rescuers of PR, is available for consultation, advice, and assistance in this and all other areas pertaining to the health, training, compatibility, etc. of the adopted pet.

Please initial here

I will take the Animal to a veterinarian within one month of adoption for a general physical examination and any necessary vaccinations, deworming, medications or medical treatment, at my own expense.

Please initial here

In the event of the employment of an attorney by PRoud Rescuers of PR, on account of any violation of this Contract, it is agreed the adopter shall pay PRoud Rescuers of PR, reasonable attorneys' fees and court costs.

Please initial here

In the event the dog is lost, PRoud Rescuers of PR, has the right to re-claim the dog.

Please initial here

I agree to notify PRoud Rescuers of PR, if the adopter has a change of telephone number or address. I also agree to notify PRoud Rescuers of PR, of any incident involving Animal control and/or complaints arising from said ownership of the pet. If the pet becomes lost or stolen, the adopter agrees to notify PRoud Rescuers of PR, immediately.

Please initial here

I agree that if any of the terms of this agreement are not met, PRoud Rescuers of PR, may reclaim this Animal at any time. Adopter will be responsible for any boarding fees, veterinary care, and training incurred by PRoud Rescuers of PR, in re-adopting the Animal. I agree to sign over the microchip information to PRoud Rescuers of PR,

Please initial here

Understanding that a Rescue houses Animals from unknown backgrounds, I assume the risks of being bitten, scratched, injured, or frightened by the Animals in connection with my visits to a PRoud Rescuers of PR, foster home or in connection with providing foster for PRoud Rescuers of PR,. I agree PRoud Rescuers of PR, is not liable to me for any injuries, damages, liabilities, losses, judgments, costs or expenses whatsoever, which I might suffer or sustain in connection with my visits to PRoud Rescuers of PR, foster home or by becoming a foster home.

Please initial here

I certify the above to be true to the best of my knowledge.

Please print your full name and date here

Adopt!