EASTERN SHORE ANIMAL RESCUE LEAGUE

Div. of Cecil County Society for the Prevention of Cruelty to Animals, Inc.

P.O. Box 665Chesapeake City, MD 21915

PH: 410-885-2342 FAX: 410-885-2910

APPLICATION FOR ADOPTION OF A RESCUE DOG

Thank you for your interest in adopting a rescue animal. In order for us to find the best match for you and our rescue animals we ask that you fill out the following application as accurately and honestly as possible.

Name:__________________________________________________________________________________________

Address:________________________________________________________________________________________

City, State, Zip:___________________________________________County__________________________________

Phone: Daytime:_______________________________________Evening:______________________________________

Email:___________________________________________________________________________________________

Who is your vet ___________________________________ phone # _________________________________________

Occupation _______________________________________________________________________________________

Please list the members of your household, with ages:_______________________________________________________

_______________________________________________________________________________________________

Who will be primarily responsible for the care of the animal?__________________________________________________

Where will the animal live during the day?_____________________________At night?____________________________

Will the animal have the run of the house, be blocked off from parts of the house, use a crate, be tied outside, or live in the yard - please explain?______________________________________________________________________________________

________________________________________________________________________________________________

Please list other pets, ages and if they are spayed or neutered?_________________________________________________

________________________________________________________________________________________________

Have you ever bred dogs/cats?__________Do you plan to?__________Have you ever crate trained a dog?______________

Have you ever obediance trained a dog?________Would you be willing to take an obedience course with your dog?________

Is your residence: House_______Condominium________Apartment_________(Are pets allowed?____________________)

Town________ City _________________ Rural__________________

Do you? Own/ Rent/ Other_____________________

Do you have a yard?______ Size?________Is it fenced?______What type of fencing?__________ How high?__________

Is someone home during the day?_________ If not, how long will the dog be alone (average)?_______________________

What is the role you see an animal having in your life? (Check as many as apply)Family pet/companion__________

Obedience work_____Agility work_____ Therapy work______ Field work/Hunting____Other________________________

Have you had dogs/cats in the past? If yes, how many?_______What breeds?____________________________________

What happened to them?____________________________________________________________________________

If you were unable to keep them, why?__________________________________________________________________

How far are you willing to drive, in hours, to look at an animal?________________________________________________

Would you consider a special needs animal, such as one that requires daily medication, one who needs obedience training, a deaf animal?________________________________________________________________________________________

Are you familiar with the cost of veterinary care?_______Licensing requirements?_______Vaccinations and heartworm preventative? __________ Are you aware of grooming requirements of an animal?_______Would you groom the animal yourself or use a groomer?________________

Do you prefer: Male_________Female______________Either__________Color Preference____________________

Do you have an age preference?_________If so, what range will you consider?________________________________

Do you have a breed preference?____________________________________________________________________

On a separate, please write a brief description of you and your family, including any special activities the dog would be involved in or special requirements you have. Also, please tell us why you want to adopt a specific type of animal.

I certify that the above information is correct to the best of my knowledge. I understand that the animal adopted from Eastern Shore Animal Rescue League will be spayed/neutered and microchipped for identification. I understand that the Eastern Shore Animal Rescue Leaguemay visit my house, possibly unannounced, to access the status of the animal and the conditions under which it is being kept. I further understand that if it is felt that the animal's welfare or safety is in jeapordy, or that the terms of the adoption contract are not being upheld, the animal may be reclaimed by Eastern Shore Animal Rescue League or Cecil County Society for the Prevention of Cruelty of Animals, Inc. I agree not to allow the animal to run lose anywhere that its safety may be jeapardized, not to chain the animal outside or to leave it in an unsafe enviroment. I also agree to accept full responsibility for the animal, its shelter, exercise, feeding and health care needs. If I ever cannot keep the animal, I understand it MUST be returned to the Eastern Shore Animal Rescue League.I agree to hold the Eastern Shore Animal Rescue League and the Cecil County Society for the Prevention of Cruelty to Animals, Inc. and their representatives not liable or responsibile for any damage to persons or property once the animal leaves their care.

Applicant's Signature:______________________________________________Date:__________________________

Co-Applicant's Signature:___________________________________________Date:__________________________

Adoption fees start at $250.00

ALL DONATIONS GRATEFULLY ACCEPTED I WOULD LIKE TO MAKE THE FOLLOWING DONATION:____________

I would like to volunteer to help the Eastern Shore Animal Rescue League in the following manner:________________________