First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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County*

Email*

Home Phone*

Work Phone
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Cell Phone

Alt Email

Which animal are you interested in?
Choose an animal: Alex Angelica Apryl Banjo Beth Bonnie Braun Bubba Carlita Chance Deitz Dugan Eddie Eleanor Ferb Gypsy Rose Haven Jellybean Kandi Lacey & Harvest Laveena Leona Levi Lola Louise Loula-Belle Lyndsay Noelle Oscar Polly Poppy REGINA Regina Rex Rollo Rosebud Rynn Sarafina Saylor Shadow Simon Kitty Sky Skyy Smeagol Theodore Timmy Toby GSD Trixie UBBA Walter Wilson

Are there any other animals of interest should the above animal be unavailable?

List the name and ages of all members of your household*

Do all members of your household agree to bringing in another pet?*
Choose one: No Yes

Have your children lived with pets in the past?*

Please list all animals currently in your home. Include whether they are spayed or neutered, up to date on vaccinations, gender, age, type of animal and breed?*

Have you ever applied for or adopted any animal from any rescue, shelter or this rescue?

Have you ever been denied previously for a animal when applying to another rescue or shelter? Reason?*

Please list all previously owned animals and what happened to them? (Gave away, accident, illness, etc)*

Are there any situations that would cause you to return or give away your animal?*

Are you aware and agreeable to our no declaw policy?

How many hours a day will your pet be without human companionship? Please explain:*

What is the name and age of the primary caretaker for the cat?*

Do any members of your household have allergies to dogs/cats?*

What kind of housing do you live in?*
Choose one: Apartment Townhouse Duplex Ranch Two Story Mobile Home

Do you own or rent?*

Please list your current veterinarian including their phone number and name on account. Also, please call you vet to let them know we will be contacting them for a veterinary reference. *

If you rent, we must be able to contact the landlord to obtain permission for this dog to live in your home. Property's owner name & phone number:

How much are you willing to spend on medical bills for your dog?*
Choose one: 0-$500 $500-$1000 Whatever it takes

What would you do if vet bills went over this amount?*

Do you use Flea & Tick Meds and Heartworm meds? If so, what kind?*

Do you plan to move any time soon?*

Where will the cat have access to?

Where in your home will the cat NOT be allowed?*

What precautions would you take to properly introduce your new cat into your home, or to your current animals?*

If a behavior or disciplinary problem arises, what steps will you take to correct it?

What would your plans be to care for the cat should you have to go away for an extended period of time or vacation?*

Are you prepared to car for this cat for 15-20 years depending on the age of the cat your interested in adopting?

If something should happen to you, ex: an unforeseeable event such as a medical issue, hospitalization, or death, do you have a friend or family member who would be willing to take your animals into their home? If so, who and what is your plan? Please provide name and contact information. *

Please list name and Phone number of 3 personal references.*

Are you willing to have an ODAAT representative come to see where the cat will be living?

I am willing to accept immediate & full responsibility for ownership of the pet. I agree to properly license the adopted pet(s) and follow all local and state regulations regarding pet ownership and control. I agree to provide the pet with yearly veterinarian exams and follow their suggested vaccinations, dental work, etc. I agree to keep the adopted pet up to date on vaccinations. I agree to provide the pet with a safe and loving home, food, water, shelter, and sufficient exercise. I agree to always bring my animal into my home at night or anytime I am unable to supervise it so my animal can be safe. In the unlikely event that I adopt a pet that is not already spayed/neutered due to medical reasons, I agree to never breed or expose the pet to unaltered animals. I agree to never abandon the animal under any circumstances to fend for itself. I agree to never leave any animal unattended outside. I agree to NOT keep any animal outside, including chained or in a pen/kennel while I am not home, unsupervised or any prolonged period of time. I agree to never euthanize the pet unless the veterinarian recommends euthanasia because of tremendous suffering. I agree to keep and consider this pet as a companion and part of the family; not as a disposable item. I agree to arrange for boarding and proper daily care in the absence of its owner(s), such as vacations., ODAAT has assessed the animal to the best of it's abilities, however, I understand that ODAAT has had this animal for a limited amount of time and makes no representation that the animal is free from characteristics or propensities that could be a source of danger to humans, other animals, or property. I agree to never surrender the pet to a third party without the express written approval of ODAAT. I understand that while ODAAT takes every precaution to assure the health of its animals, no guarantee can be given regarding the condition of the animal I have adopted and the adoption is a life-time commitment. I understand that I will be asked to give a non-refundable fee to ODAAT to help with the spaying/neutering and veterinary care of current and/or future rescued dogs. I agree to surrender the pet to ODAAT if, in the opinion of two ODAAT representatives, the animal is not being cared for properly, such as being neglected, abused, or not receiving proper veterinary care or any reason that ODAAT deems as being cared for properly. Also, if 2 or more of the ODAAT Representatives feel that the animal once placed into the adoptive home, is not adjusting well to the new home environment or dynamics, that the dog must be returned to ODAAT and the adopter will be given a full refund of the adoption fee. I have reviewed my application carefully and have read, understand, and agree to all the above conditions.

I agree to all of the following: I am 21 years or older. I can provide identification showing my present address. If I rent, I have the knowledge and consent of my landord. If I am adopting, I am able and willing to spend time and money neccessary to provide training, medical treatment, and proper care for a pet. If I am fostering, I am able and willing to spend the time necessary to care for a pet.*
Choose one: I Agree I do NOT Agree

How did you hear about us?*

I (print name) born on (Date) fully understand and agree to assume any and all risks involved in any and all duties that I perform for One Dog At A Time, also known as ODAAT in my capacity as a volunteer for this organization. Here in after jointly known as RESCUE. I understand and agree to hold RESCUE harmless for any injury or injuries which I may sustain during the course of my volunteer duties for RESCUE including, but not limited to: the risks of being bitten, scratched, injured, or frightened by cats, kittens, dogs, and puppies or any animal under my care as a volunteer for RESCUE. I understand and agree that RESCUE is not liable for any injuries, damages, liabilities, losses, judgments, costs, or expenses whatsoever that I may suffer or sustain in connection with the performance of my volunteer activities unless they are the result of RESCUE gross negligence (defined as: a carelessness and reckless disregard for the safety or lives of others, which is so great it appears to be almost a conscious violation of other people's rights to safety) or intentional misconduct. I will indemnify, defend, and hold RESCUE harmless from and against any claims, lawsuits, injuries, damages, losses, costs, or expense whatsoever sustained by any companion animal or any person in connection with my intentional misconduct or grossly negligent performance of volunteer activities for the RESCUE or with my breach of RESCUE’s rules, regulations, policies, and programs. If I will be sheltering or providing foster care or boarding for any RESCUE animals in my home or business, I consent to RESCUE visiting my home or business from time to time to observe the animals and their living quarters. I also agree that these visits may be unplanned or unscheduled prior to the actual visit. This Hold Harmless Agreement will forever prevent me from seeking any legal actions whatsoever against the RESCUE organization or any of its representatives. If you agree to the above please enter your Date of Birth, name and that you agree to the terms of the Hold Harmless Form.*