Adoption Application – Vet Research Center

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1056 Warrentown Road, Snow Hill NC 28580

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1056 Warrentown Road, Snow Hill NC 28580

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HEY! WE'RE SO EXCITED YOU ARE CHOOSING Vet Research Center TO ADOPT FROM!

Please fill out the application to the best of your knowledge. Incomplete applications will be delayed or denied.

You must be at least 18 to fill out this application. The responsible adults in the home needs to fill out this form. Children filling out this form for their parent(s) will automatically be denied. *

I Understand
I'm under 18 and filling out this form for my parents.

Did you have a specific dog you were interested in? *

Yes, but if that one is no longer available, or not the right fit, I would like to be considered for another dog in your rescue
Yes
No, I want you to match me with the right dog for me

Wonderful! What is that dog's name? *

If you are not sure you can do a description

What's your name? *

First

Last

Please provide your email. *

What's your phone number? *

Numbers only. with area code. Example: 2526862447

Please provide your address. *

Address Line 1

City

State

Zip Code

Is there another adult over 18 in the home that will also be responsible for the dog? *

Yes
No

For microchip purposes, please indicate all responsible adults.

What's their name? *

First

Last

What's their phone number? *

Numbers only. with area code. Example: 2526862447

What is their relationship to you? *

Are there additional adults over 18 in the home? *

Yes
No

What other adults are in the home? Relationship and Phone. *

What do you do for a living? *

Are there any children full time and/or part time in the home? *

Yes
No

Awe, Sweet! How many kids and how old are they? *

Are you under the age of 24? *

Yes
No

That's ok, but we do need a parent/guardian reference. *

First

Last

What is the parent/guardian phone number? *

Numbers only. with area code. Example: 2526862447

How old are you? *

For late 60's plus, we do seniors for seniors. Or you'll need a co-applicant. Subject to vet and reference checks.

Who do you want to be your 1st reference? *

First

Last

What is your 1st reference's phone number? *

Numbers only. with area code. Example: 2526862447

Who do you want to be your 2nd reference? *

First

Last

What is your 2nd reference's phone number? *

Numbers only. with area code. Example: 2526862447

Are you active military? *

Yes
No

Thank you for your service! If you get orders, who will the dog go with? *

First

Last

We require a back up plan for active military.

Back up plan's phone number? *

Do you rent or own your home? Ownership will be verified. *

I rent
I own

OK, what's the landlord's name? *

We will contact the landlord to ensure they allow dogs and check for any restrictions.

What's the landlord's phone number? *

Numbers only. with area code. Example: 2526862447

Do you currently own any dogs or cats? *

Yes
No

AWE! OK, let's fix that! Have you had any previous pets of your own within the last 7 years? *

Yes
No

OK, did they go to the vet? Name and Phone. *

Yes
No

Are all your cats and/or dogs in the home spayed and neutered? *

Yes
No

Please tell us the names, ages and personalities of your pets *

Please tell us what happened to your previous pets. *

VET REFERENCES

What vet did you take them to? Name & Phone. *

What vet do you take them to? Name & Phone. *

What's the vet's phone number? *

Numbers only. with area code. Example: 2526862447

Are the records from the vet in your name? *

Yes
No
Maybe

That's ok. Who's name are the records in? *

That's ok. Who's name might the records be in? *

Is there a second vet you went to or go to? *

Yes
No

What is the second vet's name? *

What is the second vet's phone number? *

Numbers only. with area code. Example: 2526862447

Is there additional vetting information we need to know? *

Yes
Nope, that's it!

Please be sure the vet records are under the correct names.

Please provide additional vet information *

Is the vet(s) listed going to continue being your vet? *

Yes
No

What is the name of the vet you plan to use? *

What is the phone number of the vet you plan to use? *

Please list ALL pets in the home - Type & Name. *

ALL PETS in home need to be included in application, whether owned by applicant or not.

Please tell us who your previous pets were - Type & Name. *

Do you currently have any dogs living outside on your property? *

No
Yes

Tell us why this dog is living outside *

Please explain your current pets living arrangements.

Where would the dog you are wanting to adopt from us sleep at night? *

Inside
Outside
Other

Please explain "Other" regarding the sleeping arrangements. *

Where would the dog you are adopting from us be left when he/she is alone? *

Inside
Outside
Other

Please explain "Other" regarding where the pet will be left when alone. *

Do you have a fully fenced in yard? *

Yes
No

How tall is your fence? *

What is the exercise and potty break plan? *

When you travel, who will care for the pet while you are gone? *

Under what circumstances would you not keep the pet? *

The pet may live 15+ years, what would you do with your pet if you could no longer care for the pet? *

We want you to have a back up plan.

If the pet becomes ill or injured are you financially prepared to provide medical care? *

Yes
No

Are you ok with us doing a home check? *

Yes
No

Is there anything else you would like us to know?

The more we know the less time it will take to process your application.

AGREEMENT Upon placement of this pet with me for adoption, I agree to do the following: 1. Provide him/her with kind and humane/loving treatment at all times. Make him/her your family member. 2. Provide proper and sufficient food, water, shelter at all times, and identification when outside. 3. Provide him/her with proper veterinary care at veterinary clinic. 4. I agree that this pet is to live indoors (not meaning in the garage or basement, or the likes there of) and to be outside only for periods of play/exercise and potty time. If circumstances change and I feel that this pet can no longer live indoors, she/he is to be returned to CNDR. If the pet is not returned to CNDR and/or it comes to CNDRs attention that the pet is being left outside for prolonged periods of time, especially in extreme weather conditions, I agree that the pet will be immediately removed from my care and I will not again be considered for adoption placement. I hereby give permission to CNDR to remove the pet from my possession if any of the circumstances are determined. 5. Provide him/her with daily exercise, and a fenced yard, if possible. I have been informed by CNDR that a fenced yard is preferable. 6. Comply with all state statutes and local ordinances governing the licensing and ownership of pets. If unfamiliar with those statutes and/or ordinances, I will familiarize myself with them. 7. If for any reason I am unable to keep the pet, I will contact CNDR – at [email protected] or call (252) 686-2447 immediately so that proper arrangements can be made for its return to the Rescue Program. (Please Note: we are unable to immediately pick up a pet, we have a foster network and must have space available) 8. If behavior problems arise, I agree to make all attempts to relieve the problem through professional advice and proper training; including notifying CNDR of the problem to help seek possible solutions. 9. Spay or Neuter my pet by age 6 months. I accept the pet as-is and assume all risk and financial responsibilities of adoption. I release and hold harmless CNDR its officers and assigns, any previous owner or foster home all liability associated with any illness of the pet, or damage or injury hereafter caused by the pet by any means. I agree to return this pet to CNDR upon demand, making no charges of any nature for licensing, care, food, or other services or items and also if for any reason I am unable to properly care for or keep this pet. I agree to pay any reasonable attorney fees, costs and court expenses if CNDR is forced to bring legal action against me to enforce this Adoption Agreement. *

I AGREE

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