Adoption Application

Name of Applicant:

Date of Birth:

MM/DD/YYYY

Second Applicant:

Is there an additional adult in the home:

Are there children in the home:

Street Address:

Street Address (Line 2):

City:

State:

ZIP Code:

Length of Time at Address:

Own or Rent:

Daytime Phone

Evening Phone:

Mobile Phone:

Animal You Are Looking For:

Include breed, age, gender, color, temperament, etc.

Have you had animals in the past?

Do you currently have an animal in your home?

Additional Animals At the Residence:

Do you currently have a veterinarian?

PLEASE CALL YOUR VET'S OFFICE AND GIVE THEM PERMISSION TO RELEASE INFORMATION TO OBAH -- THEY ARE REQUIRED TO ABIDE BY HIPPA REGULATIONS.

Have you adopted an animal before?

Have you ever surrendered an animal?

Have you had a pet euthanized?

Reference Name:

Reference Phone Number:

Reference Name:

Reference Phone Number:

Reference Name:

Reference Phone Number:

Employer Name:

Employer Phone Number:

Why do you want this animal?

Companion for family/self

Family Pet

Guard Dog

Companion for another pet

Hunting Dog

Other

Check all that apply.

Is anyone in your home allergic to animals?

Is someone home during the day for the animal?

Who?

How many hours will the animal be left alone per day?

Do you plan to utilize a doggy daycare/dog sitter/walker?

Is your yard contained?

Will the animal be tied up?

Will the animal spend any time in the garage?

Will the animal be crated?

Will you use Titer Testing instead of vaccinating?

Are you willing and able to exercise this animal daily?

Where will this animal be kept during the daytime?

Where will this animal be kept during the evening?

Who will care for the animal if you are gone for an extended period of time?

Include name and phone number.

If you move will you take the animal with you?

How much are you willing to spend on medical bills for this animal?

Have you ever applied to adopt an animal from OBAH before?

How did you hear about OBAH?

Why do you feel this animal would be a good fit for your family?

I am willing:

to allow an OBAH representative to conduct home visits where I will be residing with the animal.

I am willing:

to provide a safe, loving home to this animal for the next 10 to 20 years.

I will provide:

this animal proper nutrition with a grain free, all natural diet.

I will provide:

all necessary and proper medical care.

I understand that by submitting this application, I authorize OBAH to conduct reference checks as well as checking any other means to determine if I am suitable to offer a home for an animal. I also understand that because of the situation that this animal came from, I do not hold OBAH or their volunteers responsible for any unknown conditions or illnesses not identified at adoption time. I also understand that when I make this commitment to foster/adopt an animal, OBAH will be bringing this particular animal home for me and only me. We do not have a physical shelter to house these animals, so you must agree to the responsibility of picking this animal up at the designated location and caring for him/her. If for any reason, the animal does not “work out” OBAH will make every effort to rehome him/her, but you are responsible for the care in your home until this happens. I understand that this process may take weeks or months. If you are unsure, please don’t fill out an application at this time. Please wait until you are prepared for a new animal. I understand that many of these animals are very scared, timid and shy after all they have gone through, and I will take the time and appropriate steps to help the animal become acclimated to his/her new home, other pets and family members. We generally inform people that you will need to give the animal a minimum of 4 weeks before their “true colors” begin to show through. Most animals don’t take that long. I agree to provide any necessary treatment for this animal that the veterinarian deems appropriate I also understand that I am responsible for all medical bills for the animal that I foster or adopt. I agree not to breed this animal or allow him/her to come into contact with another intact animal until he/she is fixed. I understand that with unaltered animals at time of adoption, I will be required to sign a Spay/Neuter Contract and I agree to abide by ALL conditions set forth in that contract. I will provide any and all necessary training, obedience, behavioral, veterinary as well as natural/holistic assistance for this animal. I agree not to abuse (including hitting, force fetching, shock collars, etc) or neglect this animal under any and all circumstances. If for any reason this animal needs to be euthanized, I will contact OBAH first and inform them of the reason as well as providing the name of the veterinarian who evaluated the animal. Furthermore and most important, I will give this animal unconditional love and care until his time on earth has ceased. If I need to give this animal up at any time, I will contact OBAH first and make arrangements with them. I understand and agree that If I surrender this animal back to OBAH within 30 days of signed adoption, I will receive 50% of the adoption fee returned- after 30 days I waive my right to adoption fee reimbursement. If give away this animal to any person, place, shelter, or rescue without written permission from OBAH, I will withstand a $500 fine.

I have read and understand the above legal disclaimer.

Yes

Email Address

Your email will be used as an electronic signature. If approved, you will be asked to sign a hard copy of this application.