DATE: ______________________________

Dog Name:__________________________
Private Rescue Application and Contract
The following information is requested so that I can assist you in the adoption of a new dog. Dog
ownership is a serious commitment that may be expensive, time consuming and may require a
mandatory training commitment as a condition of adoption.
In order to be considered as an adopter you must:
Be 21 years of age or older.
Have identification indicating present address.
Have the knowledge and written consent of your landlord.
Be able and willing to spend the time and money necessary to provide training,
medical treatment and proper care for a pet.
For pit bull adoptions, home ownership is required as landlord requirements make it extremely
difficult to move with a pit style dog, resulting in thousands of owner surrenders to animal shelters
per year. 10,000 dogs and cats are put to sleep PER DAY in American animal shelters.
Completion of this application does not guarantee adoption of a pet.
Thank you!
About You:
Name:________________________________________________________________________________
Address:______________________________________________________________________________
_____________________________________________________________________________________
Phone:_______________________________ Cell:____________________________________________
Email:________________________________________________________________________________
Employer Information:
Employer:____________________________________________________________________________
Address/Phone:________________________________________________________________________
_____________________________________________________________________________________
Work hours per week: ________________________

Dog Owner History:

Present dog(s) age, training history, spayed/neutered/health
status?_______________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
____________________________________________________________________________
Have you ever turned a pet into an animal shelter? YES/NO

If yes, please explain.

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Please list the dogs youve had in the past, and where they are now:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Have you ever had a dog euthanized? YES/NO

If yes, please explain.

Are your present dogs able to sit, down and stay? ALWAYS

SOMETIMES

IT DEPENDS

NO

You walk you present dogs on a leash DAILY (how long ________) WEEKLY SOMETIMES
Do you have cats? Please list name, age:
_____________________________________________________________________________________
_____________________________________________________________________________________
Tell us about your home and backyard
fencing:______________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Have you participated in training classes, enlisted the services of a dog trainer, or trained dogs yourself?:
Please
explain_______________________________________________________________________________
_____________________________________________________________________________________
____________________________________________________________________________________
Training tools youre familiar with:
HARNESS HALTI MARTINAGLE COLLAR CHOKE CHAIN PINCH COLLAR ELECTRONIC COLLAR

CITRONELLA COLLAR BARK COLLAR MUZZLE OTHER: _______________________________________

Name/Age of members of your household (list children under 7 yrs. old first):
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Do you rent or do you own your home? RENT

OWN

Landlord name/address/phone (must have landlord approval):

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Time spent away from home per day: 0-3hrs

3-6hrs

6-9hrs Over 9 hrs

When youre not at home, the dog will be:

Circle one:

Crated Backyard

Free inside house Spare room Electric fence area

Tied/Tethered Garage

The dog would sleep: OUTSIDE IN YOUR BED IN A DOG BED CRATED GARAGE OTHER:____________
Do you have a swimming pool? YES/NO

Covered/Fenced?

YES/NO

If you go on a vacation, who will care for the dog? ____________________________________________

If you move, will you take the dog with you? ________________________________________________
How much do you plan to spend per year caring for your dog?
_____________________________________________________________________________________
How much are you willing to spend on medical bills for your dog? ___________________________
What would you do if you had to go over this amount?
_____________________________________________________________________________________
_____________________________________________________________________________________
Are you willing to care for this dog for 10-15 years?
_____________________________________________________________________________________
_____________________________________________________________________________________
How much exercise (per day) do you feel is necessary to keep a dog healthy and balanced:
_____________________________________________________________________________________
_____________________________________________________________________________________

What activities would your dog share with you? DOG PARK HIKING RUNNING SWIMMING AGILITY
BEACH OFF LEASH CAMPING WALKING TRAINING CAR TRIPS WORKING OTHER:____________
What are your personal priorities in owning a dog?
BASIC COMPANION FAMILY MEMBER GUARG DOG

ENJOY AFFECTION

WORK PARTNER

RANCH/FARM DOG OUTDOOR DOG

Do you feel some dogs are naturally good with children, and some arent? YES/NO
How do you feel a dog should be corrected if they do something wrong?
_____________________________________________________________________________________
_____________________________________________________________________________________

Rescue Adoption Contract

Contact information:
Dog's Name: ______________________ Breed: _______________________ Estimated Age: _____
This agreement is entered into this date by and between Valerie Fausone, and the applicant (Adopter)
for the adoption of the above identified rescue dog (the dog).
TERMS AND CONDITIONS
1. Adopter agrees to pay an adoption fee of $175 for the above named dog. The amount of $100 is
refundable provided the adopter personally returns the living dog to me within seven (7) days of its
adoption and releases me of any further liability.
2. Adopter agrees the dog is to be a family companion and agrees to provide the dog with a safe home,
adequate food, water, proper medical care, exercise, love and attention. Adopter agrees not to violate
any laws or ordinances with the dog. The dog is not to be used as an attack or protection trained dog
and will not be used for commercial guard work.
3. Adopter agrees to keep a buckle collar on the dog with ID tag, current rabies tag and town dog
license. If at any time the dog is lost, stolen, hurt or killed, the Adopter is to notify me by email or phone
immediately.
4. Adopter agrees that the dog will be confined inside the home when no one is at home. When the
Adopter is to go away for a prolonged period of time or vacation, Adopter is to prearrange proper care
for the dog.
5. The dog is not to ride loose in the bed of pickup trucks, convertibles or to be left in a car when air
temperatures exceed 70 degrees.
6. Adopter agrees to have a clean, secure fenced area for the dog. If a fenced enclosure is not available,
Adopter agrees to leash walk dog. If Adopter uses invisible fencing, the dog is to be sufficiently trained
before releasing it inside the system. Under no circumstances is the dog to be kept routinely on a runner
or tie out.
7. Adopter agrees to have the dog examined by a licensed veterinarian at least once each year and
provide for all vaccinations and treatments necessary to ensure good health. If euthanasia becomes
necessary, Adopter agrees to have it performed by a licensed veterinarian.
8. Adopter agrees to notify me of a change in address and/or phone number within two weeks of such
change.
9. Valerie Fausone makes no guarantees or statements regarding the dog's age, breed, health, or
temperament. While I have made every effort to provide accurate history and assessment of the dog, I
not able to guarantee the dogs age, breed, medical status, behavior or disposition. I am available for
consultation, advice and assistance pertaining to the health, training and compatibility of the dog.

Adopter agrees to release me from of any and all possible claims arising from injury or damage caused
by the dog to any person or property. Adopter accepts this dog as is with all defects, either observable
or unobservable, and assumes all risk for the dog upon signing of this contract.
10. If for whatever reason the Adopter is unable to keep this dog for its entire life, the Adopter must
return the dog to Valerie Fausone. Adopter agrees not to give away, sell or dispose of the dog without
express consent of Valerie Fausone. If this is turned into any shelter, Adopter agrees to pay Valerie
Fausone a $2,500 fee.
11. Adopter will allow Valerie Fausone or her agent, to conduct home visits and phone check-ins at their
discretion after adoption in order to check on the dogs welfare. Adopter and Valerie Fausone mutually
agree that if at any time during the adoption, feel the dog is not being cared for properly, or is in any
danger, I reserve the right to take custody of the dog and return the adoption fee.
12. Adopter agrees that puppies younger than 1 year will be enrolled in Obedience Training within 30
days of adoption.
13. In the event this contract, including all its covenants and conditions, is breached by Adopter, Valerie
Fausone has the right to rescind this contract and demand return of the dog. If Adopter fails to return
the dog, Valerie has the right to seek a Court Order for return of the dog and seek liquidated damages
from the Adopter in the amount of $750 plus any court costs or attorneys fees. Payment of damages
shall not excuse Adopter from returning the dog to Valerie Fausone.
14.This agreement shall inure to the benefit of and be binding upon Adopter and Valerie Fausone and
their successors or beneficiaries. Both parties have fully read and understood all of the agreement,
which sets forth all promises, conditions, and understandings, oral or written.
In testimony whereof, Adopter and Valerie Fausone sign on this date:
SIGNATURES:
Adopter: _______________________________________________________ Date:
________________________________
Printed Name:
_____________________________________________________________________________________
___
VALERIE FAUSONE: ____________________________________________________________
Printed Name:__________________________________________________________________