TENDER LOVING CANINE RESCUE

Specializing in the American Eskimo

A 501(c)(3) Non-Profit Organization

41-2061553

 

Finding New Forever Homes for Rescued American Eskimo Dogs since 2002

P.O. Box 216

Grove City, OH  43123

614-519-5705

or 614-519-3377

Ohio Chapter

Heart Bandits American Eskimo Dog Rescue

as of 01/22/06

 

 

ADOPTION APPLICATION

 

Please fill out all information in this application.

 

 

 

 

                                                                                                                                                 

Name of dog you are interested in: 
Date:

 
Tell Us About You!
Full Name :
Spouse/Significant Other :
Address :
City :
State :
Zip Code :
Home Phone Number :
Cell/Alternate Phone Number :
Email Address :
Occupation:
Spouse/Significant Other Occupation:
Type of Housing :
Own Or Rent :
For Renters.................................................................
Landlord Name :
Landlord Phone Number :
....................................................................................
   
Tell Us About Your Household!
Number of persons living in your home (including you and your spouse):

Sex:

Age:

Sex:

Age:

Sex:

Age:

Sex:

Age:

Sex:

Age:

Sex:

Age:

Sex:

Age:

Sex:

Age:
Do the children live with you full time?
How often do other children visit?
Describe your home's activity level :
Is anyone in the home allergic to animals?
   
Your Veterinarian will be contacted.  Please contact him/her and give permission to discuss your past pet history prior to our call.
Veterinarian:
Vet Clinic Name:
Address: 
City, State, Zip: 
Telephone Number: 
Veterinarian Hours:
   
General Questions:
Who will be the primary caretaker of your new pet?
Why are you considering a rescue dog?
Have you or anyone living with you ever owned a rescue dog?
Will you agree to work with behavioral issues, including obedience training if needed?
Where will the adopted dog live?
Do you have a fenced area, yard, or kennel? 
If so, what are the dimensions? Please describe the area:   
How will you exercise your adoptive dog? 
Where will the dog stay when you are not at home?
How would you transport the adoptive dog?
How are your pets maintained when you are on vacation or out of town?
Describe the characteristics that are required and that are desired in your adopted pet.
   
Tell Us About Your Other Pets!
List breeds/ages/sexes of current pets.  (We realize there may be more than three pets so if there isn't enough room, please list the remaining pets in the comment section).
Name Breed Age Sex Current on Shots Spayed/Neutered
   
Microchip/Insurance Information:
All of our dogs are microchipped.  Once you have adopted one of our dogs, they will then be registered in your name.  THERE IS NO REGISTRATION FEE!!!  The dogs are registered with 24PetWatch.  Please select one of the following:

     Yes, I consent the release of my name and telephone number to anyone that finds my pet.

     No, I prefer that communication only be through 24PetWatch or TLC Rescue.

 
Miscellaneous Information
Have you ever surrendered an animal to a local pound, animal shelter, or rescue?
If your pet was surrendered to a rescue, please provider their name and contact information.
If yes, please explain the circumstances: 
Has anyone in your family been convicted of animal abuse?  
If yes, please explain: 
Do you understand that if you are ever unwilling or unable to keep an adopted dog, the dog MUST be returned? 
   
   
   
   
Additional Information and/or Comments: 

 

 

 

I understand there is a NON REFUNDABLE adoption fee to help offset the expenses involved with the American Eskimo Rescue.   The fee is as follows:  Ages 0-1 = $300; Ages 1-4 = $250; Ages 5-9 = $200; and Over the age of 10 = $100.             YES

 

 

TLC Rescue does not warrant the temperament or behavior of the American Eskimo, and is not to be held liable for any acts of the American Eskimo while visiting the potential adopter.  Please Initial

 

 

 

 Signed:

                        Dated:

 

 

 

   

 

 

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