Rocky’s Friends Rada Miller radosti1@yahoo.com PLEASE NOTE-By signing this adoption contract you agree to all terms given to you by Rada Miller. We cannot guarantee your pets health or temperament. We will never knowingly adopt out any aggressive or "mean" animals. We do our best to evaluate all animals. We also do NOT offer refunds of any kind for any reason after the two-week trial period!!!!!! Date: ________________________ Dog/Cat Desired: ___________________ Name: ________________________________________________________ Address: _____________________________________ Apt. # ___________ City/State/Zip: _______________________________ Birth date: _______________________________________________ Home Phone ______________________ Employer: __________________________________ Work Phone _______________________ Driver's License Number: ___________________________________________ 1) How did you hear of us? ___________________________________________________ 2) Do you live in a: ___ Condominium __ Apt. ___ House ____ Mobile Home ___Townhouse ___ Other 3) How long have you lived at this address?_________________________ 4) Do you ___ Rent ___ Own ____ Other: Explain _________________________________________________________ 5) If you rent: (a) Is your lease ___ Yearly ___ Month-to-Month ___ Week-to-Week (b) Name & phone # of landlord:______________________________ ____________________________________________________ (c) Landlord approval: ___ Yes __ No (d) Restrictions (i.e., weight limit of pet) ________________________ 6) If you are a member of a Condominium or Home Owners Association: (a) Name of complex/association: __________________________________________________ (b) Restrictions (i.e., weight limit of pet) ________________________ 7) How many adults reside in the household? ________________________ 8) Are there children living in your home? _____ Ages? ___________ 9) What type of pet are your looking to adopt? _______ Dog ___ Puppy ____Cat ___ Kitten 10) Have you ever turned in an animal to an animal shelter before? __ Yes __ No (a) If yes, reason? ________________________________________________________ 11) Does it matter if the pet is housebroken? __ Yes __ No 12) Would there be anyone home during the day? __ Yes __ No (a) If yes, who? _________________________________________________________ 13) Has anyone in the household ever had an allergy to animal hair?___ Yes __ No 14) How many pets have you owned in the last 5 years?__________________ (a) If you no longer have these pets, what is the reason?______________ _________________________________________________ 15) How many dogs/cats are currently in your home?____________________ (a) Breed/Sex of dogs/cats_________________________________________________ (b) Are they spayed/neutered? ____ Yes ______ No (c) Do your dogs/cats live ___ Outdoors ____ Indoors (d) Are they up-to-date on their vaccines? ___ Yes _____ No (e) Have your cats been feline leukemia tests? _____Yes _____ No (1) If yes, what year was test done? _______________________________________ 16) Would your new pet be living ____ Indoors ____ Outdoors ______ Both 17) Where will your new pet sleep? _____________________________________________ 18) Where will your new pet be when no one is home? ______________________________ 19) Where will you new pet be while you are at home? ______________________________ 20) Is your yard fenced? ____Yes ______ No (a) Type of fence: Chain___: Height ____ Wood:__ Height _____ Cement:_____ Height ____ Other:________________________ 21) Which of the following will be provided for your new pet? ___ Doghouse _____ Patio _____Porch ____ Crate/Cage ____ Chain/Tie _____ Walks : 22) How do you control fleas/ticks on your pets? ___________________________________ 23) Who is your veterinarian? _________________________________________________ Phone # ____________________ Location ___________________________________ 24) Personal References: ___________________________________________________ _____________________________________________________ 25) Why do you want to adopt a pet? ____________________________________________ _______________________________________________________________________ Please also know that by signing this contract you agree to have your pet spay/neuter within 90 days if it is not already. Your pet must be kept indoors. If you do not abide by all conditions you forfeit all rights to the said animal. No animal may be given away to anyone or anyplace without my consent. All violators will be prosecuted!!!!!!!!!!!! I agree that all information that I have given is correct as written. _________________________________ _____________ Signature Date Additional comments: ________________________________________________________ __________________________________________________________________________ __________________________________________________________________________