Adoption Application – Useless Bay Sanctuary

Date

Name of the dog you are interested in adopting

Full Name

Occupation

Phone

Street Address

Apt/Suite

City

State

Zip Code

Driver's License Number

State

Date of Birth

Name of Partner

Partner's Occupation

Partner's Phone

Names and ages of children, if any

Do any family members have an allergy to dogs?

Yes No

Is any family member opposed to adopting a dog?

Yes No

Any other persons living in your home

List and describe regular visitors to your home (human and animal)

Do you currently have a regular veterinary clinic?

Yes No

Name, address, and phone of your vet

List two personal references, name, address, phone

Have you applied to adopt a dog through another rescue group? If so, who?

Have you ever been refused an animal adoption?

HOME

Type of Dwelling:

House Condo Apartment Other

Specify other:

Do you own/rent?

Own Rent

If renting, do you have your landlord’s written permission and is it allowed in your lease to have a dog?

Landlord's Name

Phone

If living in an HOA, do they have any pet restrictions?

Yes No

If yes, explain restriction

Contact's Name

Phone

HOA Name

How many stairs do you have?

How far do you live from a busy street?

LIFESTYLE

Will the dog’s main living area be inside or outside?

On an average day how many hours will the foster dog be left alone?

When left alone, where will the foster dog be kept?
Inside the home

Yes No

In a crate

Yes No

Crate dimension

Contained to what room(s) if any?

Do you have a doggy door?

Yes No

What areas outside are available to the foster dog?
Yard

Chain link fence height

Wood fence height

Block wall height

How many gates? Height?

Kennel Dimensions

Covered

Yes No

Enclosed Patio

Garage

Balcony

Dog house

Do you have a pool

Yes No

Is it fenced and gated?

Yes No

If you are not fenced, how do you plan to potty and exercise your dog?

Where will the dog spend the night?

When on vacation, who will care for the dog?

Pet sitter visit at home Boarding facility Family / Friends home

What would happen to the dog if you have to move locally, out of state or even out of the county?

PET EXPERIENCE

How would you rate your level of dog experience?

First time owner Intermediate Advanced

If you have children, describe their previous experience with dogs

What are your primary reasons for wanting a dog?

Below list the dogs you have now or have owned in the last ten years and explain what happened to each of them (Name, Breed, Age, Sex F/M, Spay/Neutered, Length of ownership, What happened)

Do you have any cat? If so, how are they with dogs?

Do you own any other animals?

Have you ever allowed an animal to breed?

Yes No

How many litters?

Have you ever given a pet away? If yes, why and where did your pet go?

PET CARE AND WELL-BEING

Pets are an investment of time and money. Can you offer the cost of medical care, grooming, proper diet, shelter and exercise for your new pet?

Yes No

Do you agree to never transport your dog in the open bed of a pick-up truck?

Yes No

Do you agree to a home visit by a UBS volunteer?

Yes No

Dogs can live as long as 20 years. Will you make a long-term commitment for the dog’s entire life span?

Yes No

Preferred level of exercise with dog?

Couch potato Short walks Vigorous walks

How do you normally walk your dog?

On leash Off leash

When on leash will you use?

Collar only Choke chain Harness Other

Would the dog wear a collar at all times?

Yes No

How would you discipline your dog for misbehaving, give examples

Understanding that the going rate of training sessions run approx. $150 per session, would you agree to consult and pay for a trainer or behaviorist if any problems develop?

Yes No

Who will be the dog’s main caregiver (grooming, feeding, and exercise) and their age/s?

PLEASE READ AND INITIAL EACH STATEMENT BELOW:

The rescue reserves the right to refuse adoption to any applicant for any reason.

This application and agreement becomes part of our contract. Initial

I understand that a home visit is REQUIRED prior to final placement. Initial

I understand that a home visit DOES NOT guarantee placement. Initial

Walking dogs off leash will put the dog in unnecessary danger. I understand that my dog must be under my control at all times, and will abide by local and state ordinances regarding leash laws. Initial

If you adopt a dog from Useless Bay Sanctuary, and your dog goes missing for any reason, you agree to contact Useless Bay Sanctuary immediately so we can help recover the dog quickly. Dog owners can take simple measures to prevent losing a dog and to facilitate a speedy recovery if a dog is lost (described in a separate document). I agree to read these tips and implement them to the best of my ability. Initial

If for ANY REASON, I am no longer able to provide a home to the dog adopted through Useless Bay Sanctuary, I shall immediately notify them of the situation and, with their approval, either place the dog in a home approved by Useless Bay Sanctuary or return the dog to the possession Useless Bay Sanctuary. Initial

I understand that any monetary donation/contribution is a gift given freely, not a purchase price of dog. Initial

Useless Bay Sanctuary asks for a minimum donation of $300. Initial

I would like to make an additional donation (please specify amount below) to help rescue, provide medical care, spay and neuter, board and place other abandoned dogs. Initial

All the information I have given above is true and complete. Useless Bay Sanctuary has my/our permission to contact individuals and/or businesses I have listed in the above responses. Should an unspayed or unneutered dog be placed with me, I agree to have it spayed or neutered within one (1) month of adoption or by a date agreed upon by me and Useless Bay Sanctuary. This dog will reside in my home as a pet. It is solely my responsibility to provide adequate food, water, shelter, training, affection, safety and medical care. I understand that Useless Bay Sanctuary is a rescue/referral service and is not responsible for the accuracy of information received about temperament, habits, or physical condition of the dogs available for adoption. I understand that it is my responsibility to see and evaluate the dog for myself before agreeing to adopt it. I am in full agreement with these terms of adoption. Useless Bay Sanctuary is in no way liable or responsible for any damage, accident or injury resulting from the placement of a dog into my household and I/we agree to indemnify and hold harmless Useless Bay Sanctuary and its’ officers, members, and/or agents from any claims for damages arising from actions of a dog adopted by me/us. I/we also understand that my/our dog will be micro chipped prior to adoption and that Useless Bay Sanctuary shall remain as “alternate contact” through the micro chipping service. I agree to allow a UBS representative to examine the dog and his/her living conditions, at any time if they have a reasonable belief that the dog is not being cared for in a proper manner. If the dog’s living conditions are deemed unacceptable or if I have violated the Adoption Contract in any way, I agree to immediately surrender the dog to a UBS representative.