ONE DOG AT A TIME RESCUE
ADOPTION APPLICATION
P.O. Box 76, Warsaw, IN 46581-0076
odtr01@gmail.com
DATE: _____________________NAME OF ANIMAL: ___________________
One Dog at a Time Rescue. (also referred to as ODTR) recommends a fence, either traditional or electronic for families with children under the age of 10 years. This is for the protection of both the children and the animal.
Please circle the Yes or No, whichever is applicable.
Name ______________________________________________________________
Phone (Home) _________________ Phone (Work) ________________
Address _________________________________________________
City __________________________ State ____________ Zip ___________
I am over eighteen years old: Yes No
E-mail Address *This field is required so that we may respond to you.
____________________________________________________________________
How Long At This Address? __________ Own Rent (circle)
Rental homes and apartments often have restrictions on pets. Please do not be offended but we are required to verify home ownership.
If Renting, name of Landlord: _________________________________
Landlord Phone: ______________________
Who else lives with you? ______________________
Name Relationship Age
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
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Has any one living with you ever harmed an animal? Yes No
If yes, please explain: __________________________________________________
_____________________________________________________________________
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Employment information:
Employed at _________________________________________________________
Occupation __________________________ Work Hours _________________
List previous pets: Include their breed and what happened to them? (last 5 years only)
List current pets: Name, Breed, Age, Gender, Spayed or Neutered and anything that ODTR should know about this pet.
Pet #1 Name __________________________Current on Shots Yes No
Breed _________________________ Age _________________
Gender ___________________ Spay/Neuter Yes No
Pet #2 Name __________________________Current on Shots Yes No
Breed _________________________ Age _________________
Gender ___________________ Spay/Neuter Yes No
Pet #3 Name __________________________Current on Shots Yes No
Breed _________________________ Age _________________
Gender ___________________ Spay/Neuter Yes No
Pet #4 Name __________________________Current on Shots Yes No
Breed _________________________ Age _________________
Gender ___________________ Spay/Neuter Yes No
Pet #5 Name __________________________Current on Shots Yes No
Breed _________________________ Age _________________
Gender ___________________ Spay/Neuter Yes No
If you have more than 5 current pets, please specify what & how many & circumstances.
____________________________________________________________________
__________________________________________________________________________________________________________________________________________
Name, Address, Phone # of current veterinarian.
Name __________________________________________________________
Address ___________________________________________________________
Phone: ____________________________
Please Note: ODTR will contact your vet for information on your current pets and whether they are up-to-date on their vaccines.
Do we have your permission to do so? YES NO
If yes, please sign
_____________________________________________________________________
Please note that it is an ODTR requirement to contact your current vet or former vet, if you no longer have an animal at home.
If you have never had an animal before and/or have no current or previous vet, please list three personal references.
Name Telephone Relationship
_______________________________________________________________
_______________________________________________________________
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Is someone home during day? Yes No
Where will the dog be during the day? _____________________________________
____________________________________________________________________
Where will the dog be during the night? _____________________________________ _____________________________________________________________________
Fenced yard Yes No
If yes, Fence Type and height __________________________________________
If No Fence, how will you confine your dog to your property? ____________________
_____________________________________________________________________
10. Describe your exercise plan for your dog? ______________________________
_____________________________________________________________________
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11. Describe plans for care of your dog while away: __________________________
__________________________________________________________________________________________________________________________________________
12. Are you willing to obtain a crate and crate train your dog? (Not required but highly recommended) Yes No
13. Are you willing to have a ODTR rep visit your home?(By appointment) Yes No
Please Note: If possible, a home visit is required by ODTR. If a home visit is not possible due to distance or other circumstances, references will be required. These reference along with other checks, will take the place of the Meet and Greet Procedure. Please list these references below:
Name Telephone Relationship
______________________________________________________________
______________________________________________________________
______________________________________________________________
14. What behaviors would cause you to give up your dog? _____________________
_____________________________________________________________________
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15. Describe the type dog that would fit best with your family.
_____________________________________________________________________
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16. Comments (Anything additional you would like to tell us about your family, your pets, or your lifestyle that would impact the care and affection given to this dog.) _____________________________________________________________________
_____________________________________________________________________
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MEET AND GREET DESCRIPTOIN:
Once your adoption application has been approved, and all references checked, a Meet and Greet will be scheduled, if distance is not a problem. This Meet and Greet will involve a home visit to your house with the foster parent, the animal, and an ODTR Adoption Coordinator. The purpose of this Meet and Greet will be to see how your home would fit for the animal and to meet any pets that you already have, along with all of your household members.
This Meet and Greet is NOT acceptance of your application for the specific animal that you have requested. There may be other potential adoptors or we may just not feel that this particular animal is right for you and your household. The dog WILL NOT be left at your home at the conclusion of this Meet and Greet.
Once all Meet and Greets for a specific animal is complete, a review of all acceptable homes will be conducted by the ODTR Adoption Coordinators and the proper home for the animal will be approved. You will be notified within seven (7) days after all Meet and Greets are completed as to our decision.
I understand the Meet and Greet process. ________ (please initial) Please make sure you read and understand the following: (Please read, understand and initial each paragraph)
We would not knowingly place an animal with a serious health condition. It may not be known if a stray or previously owned animal has been exposed to an illness or has a hidden genetic disorder. Under these circumstances, we cannot guarantee the health of this pet. You may have veterinary expenses for basic concerns such as ear mites or intestinal parasites (worms). If your veterinarian determines a more extensive illness at initial examination, please return the pet for an adoption refund or let us help you find another pet. You may choose to keep the pet, but additional costs incurred will be your responsibility. _________________
I understand, as previously explained, that you will be contacting my veterinarian for vaccination and health history of the pets that I currently own or have owned in the past. I release my veterinarian to provide that information to you. I am aware that if prior to placement of a pet from One Dog At A Time Rescue, my currently owned pets must be current on needed vaccines. To protect my animals at home, if they are not current, same species adoptions will require a waiting period for my own pets to gain immunities provided by the vaccines. _____________
The information I have given in this application is correct to the best of my knowledge. I
understand that ODTR reserves the right to approve or reject this application. Applications are often approved pending current pet vaccinations, fence repairs, and landlord deposits. In fairness to the animals, the selected pet may be “held” overnight to allow for time to take care of these items. An individual animal will not be taken out of adoptable status and held for an extended period of time. __________
If any misrepresentations have been made, One Dog at a Time Rescue reserves the right to demand the immediate return of any adopted dog back to One Dog At A Time Rescue. ___________
One Dog At A Time Rescue, reserves the right to refuse or deny any application for any reason. ______________
I have read and understand the Adoption Application of One Dog at a Time Rescue and agree to them.
__________________________________________ ________________________
Name Date
__________________________________________ _________________________
Name Date
One Dog at a Time Rescue Representative:
__________________________________________ ________________________
For ODTR OFFICE USE ONLY:
Home Visit on _________________________
If No Home Visit, references and whether references were checked:
_______________________________________________________________________________________________________________________________________________________________________________________________________________
NOTES: ______________________________________________________________
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__________________________________________________________________________________________________________________________________________
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Follow-up Scheduled? Yes or No Date: __________________________
Approved or Not Approved
________________________________________________________________
ODTR Representative
Date the Potential Adopter was Notified: ________________________________
Would the Potential Adopter be interested in another animal from ODTR? Yes or No
Now or in the future?
Rev 1 – 11/10/1
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