dart pet adoption form

You may fill this form out online and we will use it when you come in person.

DART reserves the right to refuse adoption of any animal to anyone for any reason.

Please list your current and past pets:
Applicant's Name:		Required
Applicant's Email Address:		Required
Applicant's Home Phone:
Applicant's Work Phone:
Applicant's Cell Phone:
Address (Home):
Address (Work):
Do You Rent or Own?	Rent Own
If Rent, what is your landlord's name?
If Rent, what is your landlord's phone number?
Where will the pet be kept during the day?
Where will the pet be kept at night?
How many adults are in the household? (List ages)
How many children are in the household?
If there are children, what are their ages?
Is anyone home during the day?	Yes No
Who will be responsible for caring for this pet?
Who will care for this pet when you go on vacation?
Are you willing to take responsibility for this pet for the next ten years or more?	Yes No
Do you have a fenced-in yard?	Yes No
What kind of fence do you have?
What is your veterinarian's name?
What is your vet's address?
What is your vet's phone number?
1. pet name:
1. pet breed:
1. sex of pet	Female (intact) Female (spayed) Male (intact) Male (neutered)
1. where is pet now?

2. pet name:
2. pet breed:
2. sex of pet:	Female (intact) Female (spayed) Male (intact) Male (neutered)
2. where is pet now?

3. pet name:
3. pet breed:
3. sex of pet:	Female (intact) Female (spayed) Male (intact) Male (neutered)
3. where is pet now?

4. name of pet:
4. pet breed:
4. sex of pet:	Female (intact) Female (spayed) Male (intact) Male (neutered)
4. where is pet now?

5. pet name:
5. pet breed:
5. sex of pet:	Female (intact) Female (spayed) Male (intact) Male (neutered)
5. where is pet now?

Are each of your pets current on rabies vaccinations?	Yes No
Are each of your pets current on heartworm preventative?	Yes No
What is the brand of heartworm preventative you use?
Are you current on flea/tick preventative?	Yes No
What is the brand of flea/tick preventative you use?
What other meds are they on?
All dogs/cats have been spay/neutered, wormed, and are current on vaccinations. All dogs/cats must be kept on flea/tick preventative and dogs on monthly heartworm preventative.
I agree to provide inside housing or fenced-in yard. NO CHAINS OR PENS!	Yes No
I agree to provide adequate, healthy food and fresh water.	Yes No
I agree to keep vaccinations up-to-date & seek medical care when necessary.	Yes No
I agree to allow a follow-up call and/or visit from us to monitor the dog or cat's adjustment prospect.	Yes No
I agree that if the adopted pet is a cat, that I will NOT de-claw.	Yes No
I agree to pay DART $200.00 as liquidation damages in the event the terms of this contract are breached. This does not prevent DART from also seeking return of the dog by judicial process or other legal means. In addition, I agree to pay reasonable attorney’s fees and expenses in the event this contract is forwarded to an attorney for enforcement.	Yes No
Dog/Cat's name you interested in adopting:
Pet's Sex	Female Male
Adoption Fee Amount

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