Adoption Application – Nykol's Rescues

Applicant's Information

Applicant's Full Name *

Age of applicant *

Names and Ages of Children (if any)

Applicant's current street address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Phone *

Alternate Phone

Work Phone

Email *

Occupation *

# of Years in Occupation

Employer Address

Address Line 1

Address Line 2

City

State

Zip Code

Employer Phone

Name of Spouse or Significant Other

Spouse or Significant Other Occupation

Tell Us About Your Home

Do you rent or own your home? *

Rent
Own

Landlord's name

Landlord's Phone

Home Type *

Single Family Home
Townhome
Condo
Apartment
Mobile Home

Are there breed restrictions with your homeowner's insurance?

How long have you lived at this address?

Do you have any plans of moving?

If yes, please state when and where.

Does your home have a secure fence?

Fence Type

May we visit your home before and after adoption?

Your plans for this dog and other pets in the home

Specific breed or name of dog you're interested in adopting *

Do you have any experience with the breed or disability of the dog that are you applying for? *

Who will primarily feed, train & exercise the dog(s)? *

The dog will live *

Indoors
Outdoors

Have you owned a dog before? *

Do you have any pets currently? *

How many pets do you have?

Types of pets and pet ages

Are these pets spayed/neutered?

Are all your pets up to date with vaccinations?

If "NO" please explain why not

Are your current dogs on monthly heartworm protection?

Yes
No
I don’t currently have a dog

What is the name of the heartworm prevention you use and where do you buy it?

Who is your current veterinarian?

Phone number of veterinarian:

How would you train this dog? *

How many hours will your pet(s) typically be left alone? *

Where are your pet(s) kept when you are away from home? *

Have you ever had to give up a dog? *

If "Yes" please explain why.

Will you be committed to potty train if needed? *

Please briefly explain why you are adopting this dog: *

If over the age of 65, what is your plan for your pet(s) in the unfortunate event of a debilitating illness or untimely death? *

Please check all boxes to acknowledge that you are in agreeance with the following statements: *

I/We certify that all the information found on this application is true and understand that false information will void the application.
I/We agree that we will RETURN the dog to Nykol’s Rescues (Nykol Smith) if for any reason we can NO LONGER keep the animal.
I/We agree that if we adopt this dog, we will provide professional veterinarian care, a nutritional diet, continue heartworm prevention medication, keep up to date on ALL vaccines/medications and give them a loving home.
I/We are aware that if the adopted animal is found to be in danger or not properly cared for Nykol’s Rescues (Nykol Smith) will take action to return the animal to the care of Nykol’s Rescues.
NO member of our household has EVER been convicted of Cruelty to Animals and agree that a background check may be done.
I/We here by release to Nykol’s Rescues (Nykol Smith), all veterinarian records for any and all animals owned by the applicant and secondary applicant.
After a home visit of 14 days, we will contact Nykol’s Rescues (Nykol Smith) to finalize the adoption and pay agreed upon adoption fee

By submitting this form I certify that the information I have given is true and accurate. I authorize the owner of Nykol’s Rescues (Nykol Smith) to contact veterinarians and references in order to investigate all statements made in this application. I reserve the right of Nykol’s Rescues (Nykol Smith) to conduct the follow up telephone calls, as well as property checks, in order to ensure the happiness, safety and well-being of my adopted companion animal. I agree to relinquish my dog/cat to Nykol’s Rescues (Nykol Smith) if at any time I can no longer properly care for the animal or if found at ANY time that I am in any way acting against this legal and binding contract.