First & last name
CURRENT ADDRESS, TELEPHONE NUMBERS (NO PO BOX)
ALTERNATIVE PHONE NUMBER
Email Address: Please list two
AGES OF CHILDREN IN HOUSEHOLD, EVEN PART TIME
CURRENT HOUSING, OWN, RENT, OPTION TO BUY
THE DECISION TO ADD A PET TO THE FAMILY IS IN AGREEMENT WITH ALL MEMBERS OF THE HOME.
ALL PETS ADOPTED ARE FOR IN HOME ONLY FAMILY MEMBERS. NOT TO BE ADOPTED AS POTENTIAL GUARD, OUTSIDE, HUNTING UNKNOWN GIFTING ETC.
YES
NO
NAME OF THE DOG/CAT YOU'RE INTERESTED IN ADOPTING? PLEASE LIMIT TO 2 PETS
IF YOU ARE ADOPTING A SMALL BREED/TOY PUP ONCE RECEIVING PUP HYPOGLYCEMIA CAN AFFECT THE PUP IT IS RECOMMENDED TO RUB KARO OR HONEY ON THE GUMS/TONGUE 2 TO 3 TIMES A DAY FOR APPROX A WEEK ONCE ARRIVING HOME. YOU MAY GOOGLE MORE INFORMATION REGARDING THIS CONDITION THAT CAN HAPPEN.
YES
NO
DOES NOT APPLY
ADOPTION FEES ARE $375 FOR DOGS AS OF 7/13/26 & PUPPIES $155 FOR CATS & KITTENS UNLESS NOTED OR DISCUSSED DIFFERENT.
MICROCHIP IS OFFERED FOR $25.00 ~ MICROCHIP WILL BE IMPLANTED WITHIN DAY OR TWO AT THE ADOPTERS REQUEST. THIS REQUEST IN NON REFUNDABLE.
YES
NO
UNDECIDED AT THIS TIME
TRANSPORT FEE IS PAID DIRECTLY TO THE INDIVIDUAL WHEN EMAILED/BILLED
YES
NO
KY/TN PICK UP
TRANSPORT FEE IS $200 DOGS/PUPS $75 FOR CATS/KITTENS
YES
NO
PICKING UP IN KY/TN
HIRING OWN SERVICE
TRANSPORTS GENERAL ROUTES STOPS FOR ADOPTERS/FOSTERS
HAGERSTOWN MARYLAND
HARRISBURG, PA
BETHEL, PA (AFTERNOON)
PARSIPPANY, NJ
DANBURY, CT
KY/TN PICK UP IN PERSON
HIRE OWN SERVICE
PETS ARE SCHEDULED FOR A VET EXAM; AT TIMES THE VET MAY FIND A MEDICAL NEED THAT WILL DELAY PETS GO HOME DATE. I UNDERSTAND THAT ADOPTED PET WILL BE RESCHEDULED FOR THE NEXT TRANSPORT/PICK UP DATE
IF THE VET FINDS A NEED TO DELAY IN A PETS TRANSPORT DATE DURING THE EXAM I WILL BE NOTIFIED BY THE EMAIL LISTED ON THIS APPLICATION.
YES
NO
IF ADOPTED PET CAN NOT RECEIVE VET HEALTH CLEARANCE FOR TRAVEL AT A LATER TIME; ADOPTERS HAVE A CHOICE OF CHOOSING A NEW PET, CURRENTLY LISTED, FUTURE LISTING OR REFUND OF ADOPTION FEE
CHOOSE ANOTHER PET
REFUND OF ADOPTION FEE
ADOPTION FEE'S ARE REFUNDED ONLY IF PET IS NOT ABLE TO RECEIVE A VET CLEARANCE/HEALTH CERTIFICATE AND CONSIDERED NOT ADOPTABLE IE HEALTH ISSUE/INTERNAL BIRTH DEFECT. REFUNDS WILL BE ISSUED BY RESCUE WITHIN 7 TO 10 WORK DAYS.
IF YOU ADOPT THIS ANIMAL AT ANY POINT YOU DECIDE TO OPT OUT OF ADOPTION TO NO FAULT OF PUP/RESCUE IE: ADOPT ELSEWHERE, CHANGE YOUR MIND ETC THERE IS NO REFUND OF ADOPTION FEE. THIS FEE WILL BE APPLIED TO THE ADDITIONAL STAY, VETTING, CARE AND OR PARTIAL SPONSORSHIP TOWARD ADOPTION FEE.
TYPE YOUR FULL NAME
I DID READ & FULLY UNDERSTAND THE REFUND POLICY. THAT IF I LISTED ADOPTER CANCEL OR CONTACT THE RESCUE STATING I NO LONGER WANT THE ADOPTED PET THERE IS NO REFUND. I FULLY UNDERSTAND THE RESCUE WILL HAVE TO START OVER IN HOMING PET WHICH EXPENSES AND VETTING IS INCURRED WHEN I CANCEL AT NO FAULT TO THE RESCUE.
YES
NO
LIST ALL CURRENT OR PAST PETS NAME, VET'S NAME & TELEPHONE NUMBER, AND ADDRESS. PLEASE CONTACT YOUR VET AND GIVE CONSENT TO DISCUSS PET'S ACCOUNT.
LIST 3 PERSONAL REFERENCES & TELEPHONE NUMBERS (NOT FAMILY OR LIVING WITH YOU)
THAT UPON PLACING SAID PET WITH ADOPTIVE HOME, YOU AGREE AT NO TIME WILL ADOPTED PET BE SURRENDERED TO A SHELTER, THAT ALL EFFORTS WILL BE USED IN AVOIDING THIS; INCLUDING CONTACTING THIS RESCUE TO ASSIST IN PLACEMENT.
YES
NO
ONCE YOU HAVE CONFIRMED ADOPTION & WISH TO HAVE 30 DAY FREE PET INSURANCE YOU WILL NEED TO CALL 1-855-710-7387 IT IS SUGGESTED TO SIGN UP AT LEAST 48 HRS PRIOR TO ARRIVAL. YOU MUST TELL THEM ADOPTED PET FOR THE 30 DAYS
YES
DO NOT WISH TO HAVE
THE INFORMATION FOR PET INSURANCE WILL BE IN YOUR ADOPTION FOLDER. ADOPTER CAN OBTAIN INSURANCE WITH THIS COMPANY FOR THE FREE 30 DAYS BY CONTACTING THE COMPANY DIRECTLY
YES
NO
CONSIDERING INSURANCE
WILL USE ANOTHER PAID PET INSURANCE AT ADOPTERS EXPENSE
I HAVE READ THE ABOVE QUESTIONS REGARDING FREE PET INSURANCE; I AM AWARE INSURANCE IS RECOMMENDED; AND TO ACTIVATE THE PET INSURANCE 2 DAYS PRIOR TO ARRIVAL TO COVER ANY POSSIBLE PROBLEMS THAT MAY POSSIBLY ARISE
YES
NOT INTERESTED
I DO UNDERSTAND THE RESCUE PROVIDES AT LEAST 2 PUPPY VACCINES PRIOR TO LEAVING RESCUE THAT THE RESCUE WILL HAVE A PUP MORE THAN 15 DAYS. ALL PETS MUST BE 8 WKS OF AGE. IF I TAKE ADOPTED PET TO PET STORES, PARKS ETC BEFORE BEING FULLY VACCINATED & 14 DAYS AFTER ITS 3RD VACCINE. THAT DOING SO CAN RUN THE CHANCE TO EXPOSE MY PET TO POSSIBLE VIRUS/DISEASES.
YES
FURTHER EXPLAIN IN EMAIL RESPONSE
YOU ARE FULLY AWARE THESE ARE SURRENDERED ANIMALS TO A SHELTER OR DIRECTLY TO THIS RESCUE INFO/BREEDS/AGE ETC WE LIST INFO THE OWNER SURRENDERS GIVE AND OR THE SHELTERS RELAYS TO THIS RESCUE.
Most of these adoptable pets have little to no vetting done until coming to rescue. Upon adopting I fully understand additional vaccines, deworming, vet apt's and vetting will be needed etc may/will be required.
YES
NO
The rescue will start all dogs/puppies/cats on a worming schedule I am fully aware worms/parasites can take multiple wormer doses to rid my adopted pet which may also include additional worming after adoption.
I also understand with a fecal on an adoptive animal can show a negative result at time of exam. Fecal's can detect parasites but said animal must have parasites passing/shedding the eggs etc. or segments for a positive results, at times parasites will also show in the fecal examined.
YES
NO
Kennel cough & other common illnesses that shelter animals come into contact with due to over crowding, stress, including transport is stressful, we have started these rescued animals on a path of proper care but at times illness can and may lay dormant with NO visible signs that are not detectable till at later times, due to more stress, upsets, changes or exposure during transport etc.
yes
no
more information
do not understand
That you have not been convicted of or have any pending charges of animal cruelty in any state. Includes neglect/abuse of any kind.
I fully agree if it is found I have submitted false information to adopt; that raises concern for said pet's welfare, or that it is found abuse/neglect is happening a rep/volunteer of our choice has all rights to reclaim adopted pet at any time and or home visit conducted.
YES
NO
If after submitting adoption fee/receiving your pup and you cancel/dispute payment. You must return adopted pet to the rescue/appointed foster home. Failure to do so will result in additional recovery costs including legal/court costs
SIGN YOUR FULL NAME
IF MY APPLICATION IS NOT APPROVED FOR ADOPTION, AN EMAIL WILL BE SENT WITH A REASON, AND ADOPTION FEE ADOPTION WILL BE REFUNDED IN 7 TO 10 BUSINESS DAYS
YES
NO
AT THE BOTTOM OF THIS APPLICATION WHEN YOU CLICK SUBMIT, IF THE PAGE THEN APPEARS BLANK SCROLL UP ON THE PAGE. LOCATE THE LOADING BAR, ONCE THE APPLICATION HAS FULLY LOADED CLICK CONTINUE IN PURPLE. YOU SHOULD THEN RECEIVE A THANK YOU PAGE AND BE REDIRECTED TO THE ADOPTION FEE PAGE.
TO CONFIRM THE ADOPTION ONCE ON THE ADOPTION FEE PAGE, SUBMIT ADOPTION FEE PAYMENT. THE PET WILL BE ON RESERVE FOR YOU FAMILY WHILE THE APPLICATION IS PROCESSED. IF YOUR APPLICATION CAN NOT BE APPROVED A REFUND IS ISSUED. NOT A CHANGE OF MIND/CANCEL/FOUND ANOTHER. ONLY IF YOUR NOT APPROVED.
BY ELECTRONICALLY SIGNING AND DATING THIS ADOPTION CONTRACT YOUR AGREE WITH ALL TERMS AND CONDITIONS LISTED.