Adoption Agreement:

Prior to adoption, it is imperative that WNY Shiba Rescue ascertain that the dog will be as loved and cared for as it deserves, for the rest of its natural life. An Adoption Agreement must be signed and accepted by WNY Shiba Rescue. Please understand that if you fail to comply with any of the terms specified herein, WNY Shiba Rescue has the right to reclaim the dog and to pursue any legal channels to do so. Our job is to ensure that each of our loving companion animals is taken care of and nurtured for the rest of her/his days.

In order to be considered for adopting a dog from WNY Shiba Rescue, you must agree to the following conditions:

1.  To accept and consider the dog as a household companion, not as an outside pet, and to provide him/her with humane care and treatment, including proper food, water, shelter and exercise, and to give him/her a reasonable amount of time to adjust to new surroundings.

2.  To provide proper medical/veterinary care, including yearly checkups, vaccinations and heartworm prevention medicine, as well as veterinary care for unusual, symptoms such as loss of appetite, coughing, vomiting, diarrhea, blood in urine/stool, allergies, skin conditions and lethargy.

     a. To register the dog with, and obtain a dog license from the municipality where I live or as required by law.
     b. To safeguard the dog from loss or mishap. This means not allowing the dog to run unsupervised.
     c. To immediately notify WNY Shiba Rescue, Petfinder (800) 666-5678,
Petline (800) 564-5704, my local vet and shelters, if the dog is lost, and to make every reasonable effort to recover the dog.
     d. NOT to give or sell the dog to another person, relative, rescue group, humane association, shelter or pound, or any medical or experimental laboratory or similar organization.
     e. NOT to change or alter the dog's appearance in any way, shape or form (e.g., cropping, docking, declawing).
     f. To immediately notify WNY Shiba Rescue in the event of death and prior to disposal of the dog's body.
     g. To allow WNY Shiba Rescue to make periodic visits to my home during the first 90 days following the signing of this and, if considered necessary, to further periodic visits thereafter.
     h. To immediately notify WNY Shiba Rescue of any change of address or telephone number within the first year following the signing of this contract, and of any change in circumstances which may prevent me from keeping the dog or to comply with any of the terms of this contract.

3.  I understand that the dog has been checked, spayed/neutered and vaccinated by a licensed veterinarian and that her/his state of health is accurately represented to the best knowledge of WNY Shiba Rescue. However, I agree to have the dog examined by a licensed veterinarian within ten days of adoption. If upon such examination it is determined that the health of the animal is not satisfactory, I may return the dog only to WNY Shiba Rescue and will not request a refund of my donation.
 
4.  I further understand that no representations are made as to the temperamental or mental disposition of the dog. Accordingly, I hereby adopt the dog at my own risk.
 
5.  I have read and fully understand the terms and conditions of this agreement, and agree that it is not arbitrary and that the provisions herein are common in pet adoption contracts. I further understand that if I fail to comply with any of the terms specified herein, WNY Shiba Rescue has the right to reclaim the dog and to pursue any legal channels to do so.

Please read the following questions carefully and respond accordingly. An answer is required for each item.

I am applying for:

What do you like most about the dog you are applying for?

Sunny

Chopper

Scout

Tasha

I would like to be considered for future dogs

OR

What are you looking for in a dog?
(Include size, breed, gender, age, temperment)

OR

What do you like most about owning a dog? Least?

Who will be the dog's primary caregiver?

General Info:

Name:

Complete Address:

Email:

Occupation:

Employer's Name:

Employer's Phone:

Complete Work Address:

Are you over 21 years old?

Yes

No

What type of home do you reside in?

Apt

House

Other

How long have you lived there?

Do you have a backyard?

Yes

No

Is it fenced in?

Yes

No

If yes, how high is the fence?

Please list all persons who reside with you. Include age and relationship.

Roommate Spouse Child Relative Friend Roommate Spouse Child Relative Friend Roommate Spouse Child Relative Friend Roommate Spouse Child Relative Friend Roommate Spouse Child Relative Friend < 1 year 1 - 5 years 5 - 10 years 10 - 15 years 15 - 21 years Adult > 60 years

Relationship:

Age:

< 1 year 1 - 5 years 5 - 10 years 10 - 15 years 15 - 21 years Adult > 60 years < 1 year 1 - 5 years 5 - 10 years 10 - 15 years 15 - 21 years Adult > 60 years < 1 year 1 - 5 years 5 - 10 years 10 - 15 years 15 - 21 years Adult > 60 years < 1 year 1 - 5 years 5 - 10 years 10 - 15 years 15 - 21 years Adult > 60 years

Name:

Does anyone have animal allergies?

Yes

No

Please list all other companion animals residing in this household. Inlclude age and breed if applicable.

Name/Breed:

Age:

< 1 year 1 - 5 years 5 - 10 years > 10 years < 1 year 1 - 5 years 5 - 10 years > 10 years < 1 year 1 - 5 years 5 - 10 years > 10 years

Have you ever owned a dog?
Please provide a brief history. If deceased, please give name and date of death.

Have you ever surrendered a pet to a shelter, rescue, or another person?
Please explain why and when.

What is your household activity level?
Please explain. Include the number of hours you are gone per day and whether or not you travel.

Who will care for the dog if you travel?

How many hours per day will the dog be alone?

< 1 hour 1 - 5 hours 5 - 12 hours > 12 hours

Where will the dog be kept during the day?

Where will the dog be kept at night?

Who will be walking the dog? How often?

Who else will be spending time with the dog?

What sort of training do you plan on providing?

Can you afford to care for a dog?

Yes

No

Would you object to a home visit before and after the adoption is completed?

Yes

No

In the event that you become unable to care for the dog, who would take responsibility for it?

Please provide the names, telephone numbers, and email addresses of two (2) people who are NOT related to you.

Name:

Phone:

Email:

Who is your local veterinarian?
Please include address, telephone number, and the name previous vet records are under.

I certify that the above information is true and accurate to the best of my knowledge, and I understand that completion of this form in no way guarantees my ability to adopt a dog.  I further understand that completion of this form is only the first step in the adoption process and that, should I wish to complete this process, an in-home screening will follow.

Sasha

Zorro

Adopting a dog is a meeting of the heart as well as of the mind. It is a lifetime commitment to an animal that will be your loving companion and your best friend. We want to make this decision as easy as possible for you, so if you are not sure you can take such a permanent step, please consider fostering one of our dogs before you adopt to help alleviate the pressure you may feel.