First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County

Email*

Home Phone

Work Phone
x

Cell Phone*

Alt Email

Text/Pager Email

Spouse's Name (if applicable):

How long have you lived at your current address?*

Do you own or rent?*
Choose one: Own Rent

If you rent, please enter your landlord's name and phone number

Current Employer & length of employment *

Current School (if a College Student)

If you are unemployed, what is your source of income:

Please provide the names AND ages of all people residing in the household. Names of children are not required but their ages ARE. *

If children do not reside in the home, but visit regularly, please provide their ages. This helps us to place dogs in a home based on their experience with kids *

How many animals are currently living in your home?*
Choose one: None 1 2 3 4 5 6 7 8 9 10 or more

Please list all animals residing in your home. For each, please include Name, species (dog, cat, bird, etc), age, gender and BREED, WEIGHT for dogs. Use "N/A" if you currently do not have any animals.)*

If animals in your home are not current on vaccinations, yearly heart worm testing and/or spayed or neutered, please name the animal(s), what they are behind on, and the reason(s) why. *

Have you had pets in the past(other than those listed above)?*
Choose one: Yes No

If yes, where are they now? Please list by name, species , where they are now & include the Vet you took them to if it is different from your current vet. *

Current veterinarian *

Vet phone number:*

If you do not currently have a vet, what vet do you plan to use:

Name of a personal reference (non-relative) that does not reside with you: *

Reference phone number:*

Reference email:

I would like to adopt a:

Name of animal (if known):
Choose an animal: Aniko Apple Brothers - McIntosh Apple Brothers - Smith Aspen Axton *FTA* Bagel Babies - Asiago Bagel Babies - Blueberry Bagel Babies - Chocolate Chip Bagel Babies - Cinnamon Raisin Bagel Babies - Jalapeno Cheddar Bella Billions *FTA* Border Collie Brats Momma Luna Butters Chondo Cooper Davonna Denver Dinky Disco Elton Football Four - Buckeye Football Four - Courtland Freckles Frederick Freddie Jasmine Knight Ryder Mama Mario (Blizzard) Mary's Pup - Joseph Mr Magoo Nano Nesta (Kitty) Nutella (Kitty) O Bros ~ Oliver Ozzy (Kitty) Peanut Butter (Kitty) Philadelphia Eagles Pups - Devonte Philadelphia Eagles Pups - Donovan Philadelphia Eagles Pups - Jaylen Poppy June Pretty Girl Raven Raven (Kitty) Roxy Russ "Hub Cap" Sammy Sampson *FTA* Shadow Smokey Sophie Meg *FTA* Spark ~ Foster To Adopt Speedy (Kitty) Suzy Q Timmy Tipsy *FTA* Trick or Treats - Skittles Trick or Treats - Tootsie Roll Willie

Do you need help selecting an animal and animal to adopt?*
Choose one: Yes, I would like guidance on choosing which pet would be the best fit for me. No, I know which animal I am applying for.

Reason for wanting to adopt a pet:*

Do you plan to declaw this cat/kitten

Will this cat/kitten be inside or outside?
Choose one: Inside only Outside only Both inside and outside

How will you handle the cat/kitten scratching unwanted items?

Do you have a fenced yard?*
Choose one: Yes No Not sure

If yes, please specify height and type of fence: *

What arrangements have you made for exercise? Please answer even if you have a fenced yard. *

Does anyone in your household suffer from allergies to cats or dogs?*
Choose one: Yes No

If yes, how do plan to handle this:

Has anyone in your household been convicted of a violent crime? *
Choose one: Yes No

If this animal is sick/injured are you prepared to spend money for its care? *
Choose one: Yes No

What will you do with your pet if you are on vacation or gone for an extended period of time? *

What circumstances would cause you to give up this pet? This answer can help us pair you with a dog. Honest, thought through answers are appreciated. *

New pets can take time to adjust to a new home, anywhere from 2-6 weeks. What is your plan for introducing your new pet in to your home? *

Where will the animal sleep*

Where will the animal be kept when you are home*

Where will the animal be kept when you are not home*

How much time will the animal spend alone during the day*

D.A.S.H. Rescue, reserves the right to follow up on the adoption in order to protect the welfare of the placed animal. If the terms and conditions of this agreement are not upheld by the adopter, or if any misrepresentations have been made, D.A.S.H. Rescue reserves the right to terminate this agreement and the adopter must return the animal to the rescue program.

I understand that neither D.A.S.H. Rescue, nor any of its representatives, is responsible for the accuracy about the information received about the temperament, habits or physical condition of the animal available for adoption. I understand that it is my responsibility to see and evaluate the animal for myself before agreeing to adopt it. I am in full agreement with the terms of adoption. In redeeming an animal from the program, I accept full and complete responsibility for the actions of the animal in the event of injury or death to myself or others and to indemnify and hold harmless D.A.S.H. Rescue, including its representatives for any such personal injury, death or damaged caused.

I agree to the terms of the release of liability*

I understand I will need to email DASH several photos of the inside of my home and yard. This is the start of your home visit process for adoption. We use this information to ensure a safe home environment for our animals. Once we receive the photos, we will begin to review your application. If you are applying for a dog, please send photos to dashrescue00@gmail.com If you are applying for a cat please send your photos to catsdash9@gmail.com. Application review will begin upon receipt of these photos. *

I agree to send photos to dashrescue00@gmail.com if I am an if I am applying for a dog or to catsdash9@gmail.com if I am applying for a cat. Application review will begin upon receipt of these photos.*

I acknowledge and understand that DASH reserves the right to refuse adoption to any applicant at any point in the application or adoption process, at its sole discretion. Furthermore, approval of your application is NOT a guarantee that you will be allowed to adopt the animal of your choosing (or any animal). DASH strives to take the best interests of our rescue animals into consideration when making placements. We want this home to be theirs Fur-ever. *

Signature (type name if email applicant):*

Date:*