NC Rescue League Adoption Application

About the dog you want to adopt

Name of pet applying for:

Do you have a second choice?

If no specific dog, describe what you're looking for:

Why do you want to adopt a dog?

Personal / Home Information

Please enter your e-mail address: *

What is your occupation?

Name and Address:

First : *   Last : *

Street Address : (please, use your home address)

City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Massachusetts Maryland Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip:

Living at current address for 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 + years and 0 1 2 3 4 5 6 7 8 9 10 11 months.

Telephone Number(s):

Home: Cell: Work:

Which number(s) is/are best to contact you? * Home Cell Work

Is your home rented? No Yes

Landlord's name and phone number

Please provide us with some information about your lifestyle:

Number of persons in household: Adults: 0 1 2 3 4 5 6 7 8 9 10 children: 0 1 2 3 4 5 6 7 8 9 10

Does anyone in your home have allergies? No Yes

Do you have a swimming pool? No Yes

Do you have a fenced yard? No Yes

If so, is it attached to the home? No Yes

Do you object to a home visit by NCRL prior to adoption? No Yes

Pet Questions

Total number of pets owned in the past 5 years: None 1 2 3 4 5 6 7 8 9 10 + *

Veterinarian Name:

Veterinarian Hospital Name:

Telephone :

Address: City:

State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Massachusetts Maryland Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip:

Is this the veterinarian you plan to use for your new pet? No Yes

Do you give NCRL permission to contact your veterinarian? No Yes

General Questions

Do you use a run line for exercise or a tie out? No Yes

Will the dog have the run of the house? No Yes

How long would the dog be alone on a typical day? 18+ hours 12 - 18 hours 9 - 12 hours 4 - 8 hours 1 - 4 hours 0 - 1 hour

Where will you keep your pet?

Who will be the primary caregiver for the dog?

Have you ever given a pet away or re-homed a pet? No Yes

If so, how and why?

Is there anything else you would like for us to know?

Adoption Agreement

By selecting 'I Agree' below, I understand my new pet deserves a safe, secure, protective, and loving environment, proper medical attention and preventative care including, but not limited to, monthly heartworm and flea prevention and veterinary care as needed, and agree to provide such to my new lifetime companion. I agree to provide proper shelter at all times.

I also understand NCRL evaluates and describes each pet to the best of their ability. Therefore, I agree that I will accept full responsibility of my lifetime companion and his/her health at the time of adoption. I understand all the adoptions are final and there will be no cash refunds.

I also agree if I am no longer able to care and provide for my new pet, I will return him/her to NCRL for new home placement.

Authorization

By selecting 'I Agree' below, I agree that I have read and understand this Adoption Agreement is a binding contract and agree to abide by the terms and conditions listed above.