Full name of applicant who will be responsible for this dog:
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First Name
Last Name
Date of Birth
MM
DD
YYYY
Name of pet that you are interested in adopting:
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How did you hear about this dog?
Email Address:
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Address:
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Home Phone:
Cell:
Are you on Facebook?
FB name
Place of Employment
Work Phone
(###)
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What qualities are you looking for in a pet?
Please list all adults (over the age of 18) living at this residence:
Are all adults living in this household agreeable to adopting this dog?
Number of children living in household and ages:
Does anyone in the household have allergies to animals?
Is this adoption a gift for someone else?
If "Yes", please explain:
Will the dog be kept at a different address?
What type of residence do you live in?
Do you own or rent your residence?
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How long have you been at this residence?
Does your homeowner's insurance or renter's insurance have any breed restrictions?
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If yes, what breeds are restricted?
If you rent, please supply the name and contact number for your landlord:
Does your property have a front/backyard?
Is the yard enclosed with fencing?
If "yes", what type of fencing?
Where will this pet live? (Check all that apply)
How many hours/day on average will the dog be home alone?
How will this pet spend its time home alone? (Check all that apply)
Where will this pet sleep at night?
Will any other pets be in contact with your new pet on a regular basis?
If yes, please explain:
How are you planning to socialize and exercise this pet?
If you move, are you willing to bring this animal to live with you in your new residence?
What if the new home does not allow pets?
Personal References: Please list three references (noting relationship) and contact number. At least two references must be non-relatives.
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Do you currently own any other pets?
If yes, please list current pet(s) name(s) type/breed/age(s):
VET REFERENCE: Name of Vet (that you currently used, have used in the past or will use for your new pet)
Vet Location:
Vet contact number:
Are your current pets spayed/neutered/up to date on shots?
Are your current pets on monthly flea/tick preventative?
Are your current pets on a Heartworm preventative?
Which product is used?
Where do you purchase this product?
Are you aware that the regular veterinarian bills can run between $100 & $500 a year?
Are you aware that an emergency vet visit can run anywhere from $500-$5,000 per visit?
Are you prepared to spend these amounts if necessary?
Pet Experience & History: What type(s) of pets (cats, dogs, horses, etc.) have you previously owned in your lifetime?
Please list each and what happened to them?
Have you ever given a pet to a shelter?
If "yes", please explain:
Have you ever had to euthanize a pet?
If "yes", please explain:
Are you willing to participate in training programs or behavior classes if your pet requires it?
Please initial or sign after reading and agreeing to these terms: GKDR believes that all pets should be indoor-only pets. The animals we adopt out are never to be allowed to roam outside due to the potential hazard of getting hit/run over by vehicles, injuries from other wild or domesticated animals/spreading of disease.
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First Name
Last Name
Good Karma Dog Rescue has a “no refund” policy. Is this acceptable to you?
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Please initial or sign after reading and agreeing to these terms: Good Karma Dog Rescue reserves the right to reclaim any animal that is found chained or bound in an inappropriate manner, abused, neglected, or improperly cared for.
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First Name
Last Name
Pledge I pledge to make a reasonable commitment of time and effort and to adjust scheduling and lifestyle in order to make this relationship work. I understand that I may need to confine and seclude this pet in my home in order to provide an adjustment period and build a relationship by earning his/her trust.
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First Name
Last Name
RELEASE OF LIABILITY: I, release GKDR, volunteers, foster volunteers and representatives of GKDR from any and all claims and actions, whether it’s for property damage caused by the animal(s) or for personal injury to me, family members, other persons and other animals (including personal pets, livestock, or other animals) from biting, scratching, transmittal of disease, and/or any other matter attributable to said animal(s).
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First Name
Last Name
MEDICAL RELEASE OF LIABILITY: Good Karma Dog Rescue will not be responsible for any medical bills for your pet after adoption unless arranged for at time of adoption.
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First Name
Last Name
I/We further understand and agree: 1. To return the dog to GKDR if unable to keep the dog. To never abandon the dog or surrender, sell, or give the dog to a shelter, pet dealer, or a laboratory. 2. To notify GKDR if the dog is lost or stolen and to make all reasonable efforts to locate the dog. 3. To never allow this dog to be trained for or used for protection or as an attack dog. 4. To treat this dog as a family pet with affection and kindness, never subjecting this dog to abuse or cruelty. 5. To provide regular veterinary care, including annual shots, heartworm preventative, and parasite checks. 6. To always keep this dog within a fenced yard (not on a chain), on a leash, or safely within the home. 7. To not transport this dog unconfined in an open vehicle. 8. To regularly check the tightness of any collar. To affix any licenses and tags to the collar and to never leave a choke chain on the dog when not attended. 9. To permit GKDR to make follow-up calls and/or visits. 10. To contact GKDR, a veterinarian, or an obedience trainer when problems arise so that the problem may be eliminated or alleviated. I/We further understand and agree that: 1. Non-compliance with any of the above terms and conditions may result in the immediate forfeiture of the dog and that GKDR may reclaim this dog without payment of compensation to me/us. 2. GKDR has explained the typical characteristics and temperament of the pet. 3. GKDR has advised me/us that the dog can sometimes dig, chew, soil, and exhibit other undesirable traits unless properly supervised, confined, and trained. 4. GKDR has given me all information necessary to make an informed decision to adopt this dog. In consideration of the adoption of this dog, I/we agree to assume full responsibility for the conduct of this dog upon the date of this contract. I/we further agree to hold harmless GKDR, its volunteers, and any individuals associated with GKDR and to indemnify such organizations or individuals for any damages or costs resulting from liability, known or unknown, anticipated or unanticipated, as a result of the dog's conduct after the date of this adoption contract. I have read the terms of this application and the adoption of the pet that I am applying for, and by signing below I certify that the information I gave in this application is true, and any misrepresentation of facts may result in my losing the privilege of adopting a pet through GKDR in the future and the forfeiture of this dog or cat. Also by signing below I agree to all the terms as set forth herein by GKDR in this application.
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First Name
Last Name
Date
MM
DD
YYYY
Thank you for submitting your application. Your application will be forwarded to the Good Karma Dog Rescue Board of Directors for screening.
We will reach out to you as soon as possible to discuss the next step.
• The general adoption process is as follows:
• Once we receive your application, the Good Karma Dog Rescue Board of Directors will review it to see if the dog you are interested in may be compatible with your family.
• Once your application has been screened, we will arrange a meet and greet with you and your family members (including pets) and the dog you are interested in.
• During this time, one of our foster coordinators will be contacting your references and your veterinarian.
• If the meet and greet was successful, and any other potential adopters have been ruled out, we will move ahead with the adoption.
Thank you again. Please do not hesitate to reach out with any additional questions.
