Bonaparte"s Retreat Adoption Application

Today's Date *

Date

Applicant's Full Name *

First Name Last Name

Co-Applicant's Full Name

First Name Last Name

Address *

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

E-mail Address *

Secondary E-mail Address

Primary Phone Number *

- Area Code Phone Number

Secondary Phone Number

- Area Code Phone Number

Your Birth Date(s) *

Your Employer(s) *

Name of the animal you want to adopt: *

Have all the adults in the household agreed to adopt? *

Yes No

List the gender and ages of all family members living in the household, including yourself: *

Is the dog primarily for: *

Adult Child Family

Is your family's activity level: *

High Medium Calm

What qualities are you looking for in a dog? Check all that apply. *

Protection Companionship Company for other pets Apartment living Hiking/Walking Outdoor activities Gift for someone Hunting

Who will care for, train, and exercise the dog? *

How long have you lived at your current address? *

Do you: *

Own Rent

If you RENT, do you have your landlord"s permission to adopt a dog? *

Yes No Not applicable

If you RENT, provide landlord"s name and phone number.

Does your landlord have weight or breed restrictions for pets?

Do you have a fenced yard? *

Yes No

If YES, what TYPE (material) of fence?

HEIGHT and LENGTH of fence?

If NO, do you have plans to install a fence?

Yes No

[NOTE: Bonaparte's Retreat often requires a home visit before an adoption is finalized.]

Are you familiar with use of a dog crate to train your adopted dog during your absence or at night? *

Yes NO

Will the dog be (check all that apply): *

Walked daily Exercised in a fenced yard

Will the dog receive formal obedience training? *

Yes No

If YES, where or by whom will your dog be trained?

Will the dog be allowed inside the house? *

Yes No

How many hours will the dog be left alone each day (without human company)? *

Where will the dog stay when you are away from the house each day? *

Where will the dog stay when you travel? *

How will you keep the dog confined to your property? Check all that apply. *

House Kennel Fenced yard Chain Garage Leash Dog run Patio

If you move from your current residence, what will you do with your dog? *

Briefly describe your previous dog experience. Include a list of all pets (species, breed, gender, age) you have owned in the past five years, including current pets. *

Are the animals in your home living harmoniously? *

YES NO Not applicable

If NO, please explain any behavioral issues among the animals in your home.

Are all the animals in your home spayed/neutered AND up to date on vaccinations? *

YES NO Not applicable

Are you prepared to allow a new dog a minimum of three weeks to adjust to its new adopted home? *

Yes No

What would cause you to return your adopted dog? *

Tell us a little about your lifestyle and your family/household, including any special activities in which your adopted dog would be included. *

CURRENT OR PREVIOUS VETERINARIAN

List your current animal care provider or a previously used clinic for the pets you've had in the past five years.

Have you used a vet clinic or veterinarian in the last five years? *

YES NO

If YES, provide Clinic name, address, and phone number below.

Clinic Name

Veterinarian Name

Vet Clinic Address

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

Vet Clinic Phone Number

- Area Code Phone Number

Where do you purchase heartworm preventative?

Do you understand the state and local ordinances concerning leashing? *

Yes No

Have you or any member of your household been cited for leash law violations or cruelty to animals in the past? *

Yes No

If YES, please explain.

Have you sold, given away, or surrendered a pet to a shelter? *

Yes No

If YES, please specify.

Have you ever been convicted of a felony or misdemeanor? *

Yes No

If YES, please explain.

REFERENCES

Please provide two non-family references who can speak about your capacity to love and care for your pet (such as a friend, neighbor, pastor, veterinarian, etc.):

Reference Name & relationship to you *

Phone Number

Reference Name & relationship to you *

Phone Number

How did you hear about Bonaparte's Retreat Dog Rescue? Have you applied for a dog with us previously? *

Are you aware that the routine costs of maintaining a dog average more than $500 per year? *

Yes No

Can you commit to providing a responsible home for your adopted dog's entire life, perhaps 15 years or more? *

Yes No

If this adoption is approved, will you allow Bonaparte's Retreat to place a photo of you and your new pet on our web site, social media, and/or general marketing materials? *

Yes No

I understand that if this adoption is approved, there is a minimum three-week trial period during which either party may change their minds. I also understand that the adoption fee is $125--or $75 for senior and special needs dogs (a senior is any dog 7 years or older) . *

Yes No

DISCLAIMER AND RELEASE: Many of the dogs in our program come to us from Animal Control facilities. Our veterinarian screens for noticeable health problems and vaccinates each dog. Each dog is placed on heartworm prevention and is given flea and tick preventative. Even with this care, however, a small percentage of dogs may require vet care or become ill shortly after adoption or while fostering. I understand that Bonaparte’s Retreat offers no warranty or guarantee as to any animal’s disposition, physical condition, health, or ability to interact with any person or other animal. I understand that there are certain risks inherent in interacting with animals I fully understand all risks associated with and inherent to my meeting, interacting with, and caring for an animal and fully assume said risks for injury, loss, or damages of any kind resulting from such risks involved in any associated activities. I hereby agree to release and forever discharge and hold harmless Bonaparte’s Retreat and its directors, officers, employees, agents, volunteers, invitees, sponsors, donors, and all other persons or entities whomsoever from any and all claims (including liabilities, suits, or expenses), whether known or unknown, including claims caused or alleged to be caused by the negligence of Bonaparte’s Retreat or its directors, officers, employees, agents or otherwise, for injury, damage, death or other loss to me, my property, or the persons and property of third persons, in any way connected with my decision to become an animal care provider. I understand and hereby agree to waive all claims I may have against Bonaparte’s Retreat and agree that neither I nor anyone acting on my behalf will make a claim or file a lawsuit against Bonaparte’s Retreat. Please let us know if you have any questions regarding this disclaimer and release.

By checking the box below, I acknowledge that I have read the above DISCLAIMER AND RELEASE. *

true

I agree to the terms and conditions as stated above. By selecting "I agree" I acknowledge that all information provided is true and accurate. If any of this information is not true and I am approved for a dog, I understand that I will be required to surrender the dog back to Bonaparte’s Retreat. *

I AGREE I DO NOT AGREE

SIGN HERE usng your touch pad or mouse. *

Clear

Press the SUBMIT button below to submit your application.

ADOPTION APPLICATION