EmailMe Form - The Pitty Committee Adoption Application

Your Name *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone *

### - ### - ####

Email *

What is your occupation & place of work? *

Instagram Handle (Optional)

Facebook Link (Optional)

Web Site (Optional)

What is the name of the Dog that you are interested in adopting? *

Which option best describes your current property? *

Do you currently rent or own your property? *

I own my property.

I rent my property.

If you currently rent your property, do you have prior consent from your landlord to have animals in the home? *

Yes

No

Not sure

This does not apply to me

Do you have any other animals living in your household? *

Yes

No

Please list all animals currently living in your household. Include animal's name, age, and breed (if known). *

Please list the temperament of each animal living in your home. *

Please list whether the animals in your home have been spayed or neutered. *

Are there any children living in your home (18 and under)? *

Yes

No

If yes please list the names and ages of all children within household. *

If you have minors in the home, please briefly detail their experience and comfortability with animals. *

Are any other adults (besides yourself) living in your home? *

Yes

No

If yes, please list the names and relation of all other adults within household. *

If you have other adults in the home, please briefly detail their experience and comfortability with animals. *

Does your property have a fenced in yard? *

Yes

No

If yes, please describe it in the box below to the best of your ability. Is it 100% secure? How tall are the fences? Is there any potential for the animal to get out? *

Please describe yours and your family's current lifestyle and schedule to the best of your abilities (i.e.: work, gym time, sports, traveling, etc.) *

How long will the dog be left at home alone during a standard weekday? *

How long will the dog be left at home alone during a standard weekend day? *

Where will your dog reside during the daytime? *

Please describe where your adopted dog will sleep at night. *

Please briefly describe your expectations (if any) for your adopted pet. For example, do you want to take your dog on hikes, do you want a buddy at home, do you want a companion for your current resident pet, do you want a dog that can travel, are you just looking to add another pet to the family? etc. *

If any issues arise with your pets behavior, would you provide the animal with training at your expense? If not, how do you plan to handle it? *

I waive all rights and claims against rescue regardless of the expense or damages incurred upon adoption. I will not pursue legal action against rescue and will hold all rescue personnel harmless in the event that any injuries to persons or damages to property arise *

Agree

I will provide sufficient food, water, shelter, exercise, love and care for my pet *

Agree

I will keep my pets microchip up-to-date *

Agree

I will keep my pets necessary vaccines up-to-date *

Agree

I will keep my pets license up-to-date *

Agree

I will provide all veterinary care necessary for my pet at my expense and will not allow my pet to suffer with treatable health conditions *

Agree

If I have other animals and people in the home, I will safely integrate my new pet with proper introductions *

Agree

I understand that I am adopting a rescue dog that has an unknown history who may, in some instances, take a little extra time to settle in *

Agree

I will not use this animal in ANY sort of fighting, breeding, or cruelty *

Agree

I will not euthanize this animal unless health issues arise where euthanasia would be the only humane solution and not before discussing with rescue *

Agree

If under any circumstances I can no longer provide care for my dog, I will contact the Rescue to make plans to return them. I will not take the dog to a shelter or transfer them to another party, otherwise I may be subject to a $25,000 fine *

Agree

If under any circumstances I can no longer provide care for my dog, I will give the rescue 30 days notice in order to relocate dog, otherwise I will be responsible for boarding costs until new placement is found *

Agree

I will provide Rescue with a tax-deductible donation of $350 for the adopted animal which may be made through Venmo/CashApp (PittyCommitte), Zelle/Paypal (ThePittyCommittee@gmail.com) *

Agree

DISCLAIMER: By typing your full name below and submitting your signature in the next field, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application and are hereby acknowledging that all of the information provided within this application on your behalf is absolutely true and correct. *

Signature

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Please select today's date below: *

MM / DD / YYYY