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Online Adoption Form



 If you do not receive an e-mail telling you we have received the form from the online submission, it was not received.

 Thank you! 

* Required fields
Name *
E-mail Address *
Name & ID # of dog, or breed of dog you wish to adopt: *
Phone number including area code *
Address *
City *
State *
Zipcode *
Applicants Date of Birth *
Occupation of applicant *
Spouse/ Roomate name
Occupation of Spouse/Partner
Spouse/RoomMate's Date of Birth *
Do you ?
Type of Home you live in *
How long have you been at your current home? *
Enviroment you live in *
If renting, we will need a statement from your landlord giving his/her permission for you to have a dog at the above address. Please provide Landlords Name, Address and Phone Number
Are you planning on moving in the next 12 months? *
Number of children in your home *
Ages of Children in your home
Number of adults in your home ( including you) *
Relationship between Adults *
Any persons with allergies in the home? if so what are they? *
Does every member of the house hold agree to adopting this animal? *
How many hours at any one time will the dog be left alone while members are at school/work? *
Please list ALL Pets you currently have living with you. Name, Age, Breed, Years owned, From where pet was acquired, Spayed, Neutered or Intact.
Are all your pets spayed and neutered? *
Please list pets you no longer have: Name, Breed, Spayed/Neutered? When did you have this pet? Where is it now?
Please list current and past Veternarians and their phone numbers for the last 10 years *
Please contact your current Veterinary to let them know we will be calling. They can not release any information without your permission
What type of dog are you looking for? (check up to three) *
Activity Level of your home *
Is this your first experience as a dog owner? *
Using these options, describe your back yard. *
Describe the type of fencing you have.
Please describe how you plan on exercising your dog:
Do you know how to crate train a puppy/ dog? *
Do you know how to housebreak a puppy? *
Where will your dog be when you are at home? *
Where will the puppy/dog sleep at night? *
Where will the puppy/dog be kept when no one is home? *
What arrangements will you make for the dog/puppy when you are on vacation? *
Are you familiar with canine heartworm disease and preventative? *
• Are you familiar with Animal Control ordinances and required licensing in your area? *
• Have you ever taken a dog to obedience classes? *
• Are you planning on taking this dog/puppy to classes? *
• Do you understand the financial cost of owning a dog? *
Are you planning on taking this dog/puppy to a vet within 30 days of adopting them? *
Are you familiar with introducing your new dog/puppy to children, people and animals of your household? *
Would you agree to a "home visit" (by appointment) by one of volunteers either prior to or just after adoption? *
• Puppy Adopters – you will be legally obligated to have the puppy spayed/neutered by the age of 6 months and provide us with a copy of the spay/neuter certificate for our files. Are you willing to comply? *
REFERENCES: Please list three references that are familiar with your family and lifestyle (only one relative please)
Reference No. 1 - Name Address Phone, Relationship *
Reference 2- Name-address-phone- relationship *
Reference 3- Name address- phone- relationship *


Please take a moment to review your application.  Omission or unclear information may delay or prevent approval.


Upon adoption- you will be expected to sign a contract with these rules of adoption. 

Please review before final submission of your application.


I have read the above information carefully and have filled out this application to the best of my knowledge.  I understand that omission of information and/or failure to answer all questions honestly can result in this application being declined.  I give “Rescue Me” and its associates’ permission to fully investigate the information provided, as well as contact veterinarians and related persons and officials. In addition, I understand the adoption decision is dependent on many factors, including but not limited to, the compatibility of the family and home to the individual animal, and other applications received on this animal.


By signing this contract, I attest and swear that all information is accurate and true to the best of my knowledge and that I have never been charged or convicted of animal abuse, neglect or maltreatment.


All dog adoption contracts approved by Rescue Me–Purebred K9 Rescue, Inc., are subject to the following terms and conditions:

  1. The Adopter (herein known as the individual adopting the said name dog) agrees that the dog will be kept only as a domesticated house pet.  This means that the dog will be kept indoors, as a part of the family, except for periods of exercise in a fenced-in area or on a leash.
  2. The Adopter agrees to adhere to all local licensing requirements for the dog.  The Adopter will be given proof of spaying/neutering and rabies vaccination in order to obtain the licensing.  The license must be obtained and a copy presented(mailed) to Rescue Me.
  3. In the case of adopting a puppy and the puppy has not been spayed/neutered, the Adopter agrees to have said puppy spayed/neutered by seven months of age and to provide Rescue Me with such documentation that the procedure has been completed by their veterinarian.  Further, licensing of the puppy must be obtain according to local licensing requirements (usually one year of age).  Proof of licensing should be sent to Rescue Me.
  4. The Adopter grants Rescue Me the right to make periodic visits to the Adopter’s premises for the purpose of checking on the general health and welfare of the dog and to assure that spaying/ neutering/licensing has been adhered to according to the terms and condition of this agreement.
  5. The Adopter herein states that he/she is 19 years of age or older and that all family members are in agreement with this adoption, and to their knowledge, no one in the home is allergic to dogs. 
  6. The Adopter represents that he/she has never owned an animal which has been confiscated by the Animal Control Officer or Humane Society in violation of state or local animal control regulations or animal adoption contracts.
  7. If the Adopter is leasing an apartment, he/she agrees to provide written permission, along with a phone number of the landlord, allowing the dog to reside in the apartment.
  8. If for any reason the Adopter is unable to provide care for the dog, the Adopter agrees to return said dog to Rescue Me.  The Adopter shall not offer the dog for sale or give the dog to any third party without prior written consent of Rescue Me.
  9. The Adopter agrees that Rescue Me shall have the right to immediate possession of the dog if, in the judgment of Rescue Me, the dog is receiving inadequate care, being improperly housed or handled, or has not been spayed or neuter on or around the date agreed as of the signing of this contract.
  10. The Adopter agrees to pay Rescue Me the sum of $300.00 as liquidated damages in the event the terms of this contract are breached.  This liquidation of damages does not bar Rescue Me from seeking return of the dog by judicial process and/or other legal means if necessary.
  11. The Adopter hereby declares that they have been made aware that a dog’s behavior/personality may change after it leaves Rescue Me and accustoms itself to their new home and environment.  And, further, Rescue Me makes no representations or warranties as to the temperament, health, or mental disposition of any dog put up for adoption. 
  12. The Adopter fully understands and agrees that there will be NO REFUND OF THE ADOPTION FEEshould the adoption not be successful.  We make every effort to place our dogs in permanent homes whereby they will not be returned, as this can cause undo stress on the dog.
  13. The Adopter hereby accepts possession of, title to (subject to the conditions of the adoption contract) and responsibility for said dog adopted and agrees to release and discharge Rescue Me forever from liability for any injury or damages to any person or property caused by the adopted dog, and from any causes of action, claims, suits, including legal fees or demands whatsoever that may arise as a result of such injury or damages.
  14. THE UNDERSIGNED understands that the parties hereby released and admit no liability of any kind by reason of the said adoption and that said adoption fee is made to terminate any further controversy respecting any and all claims for damages that said Adopter(s) has heretofore, asserted or might personally or through personal representatives hereafter assert because of said adoption.
  15. By placing my signature below, I release Rescue Me-Purebred K9 Rescue, Inc. of any and all liability issues concerning this dog. From this day forward.  I have been informed of any and all behavioral issues known by the rescue including, but not limited to, previous bite history.  The rescue has also informed me of all known health issues concerning this dog, past and present, and fromt his day forward is released from any and all liability.      Please Initial:_________