Useless Bay Sanctuary, a nonprofit rescue for lost dogs.
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Below is the text of our adoption application. You can copy this text and paste into an email or a word document, and then send it to us by email or postal service. Thank you.
Useless Bay Sanctuary
P. O. Box 904
Seahurst, WA 98062
www.UselessBaySanctuary.org
ADOPTION APPLICATION / AGREEMENT

Completion of this application does not guarantee adoption of a rescue dog from Useless Bay Sanctuary, as we reserve the right to refuse any applicant.

Date___________________ Desired Dog______________________________________________________

Name of Applicant _____________________________ Occupation _________________________________

Home phone ( ) _______________ Cell ( ) _______________ Work ( ) _____________ ext_____ Best time to call____

Home address____________________________________________

Email Address _______________________________________________________________

Driver’s License Number _________________________________State_____ Date of Birth ______________

Name of Spouse/Significant Other _________________________ Occupation_________________________

Cell ( ) _________________________Work ( ) _______________________ext_____

Email Address ____________________________________________________________________________

Names/Ages of Children, if any_______________________________________________________________
________________________________________________________________________________________

Do any family members have an allergy to dogs? ________________________________________________

Is any family member opposed to adopting a dog? _______________________________________________

List and describe regular visitors to your home (human and animal) _________________________________

List name/ ages of any other occupants your home_______________________________________________

REFERENCES:

Do you currently have a regular Veterinary / or Veterinary Clinic? Y______N_____

Name/address/phone_______________________________________________________________________

List two personal references:

Name/address/phone_______________________________________________________________________

Relationship________________ How long known ____________________

Name/address/phone_______________________________________________________________________

Relationship________________ How long known ____________________

Have you applied to adopt a dog through another Rescue group? ______ If so who? __________________

Have you ever been refused an animal adoption? __________________________

HOME:

Type of Dwelling: House ____ Condo ____ Apt. ____ Other _____ Do you Own ____ Rent _______

If renting, do you have landlord’s permission it’s allowed in your lease to have a dog? Y____N____

Landlord Name: _______________________________________________ Phone ( ) ________________

How long at this address? ________________________________

If living in an HOA, are there any pet restrictions? Y___N___ If Yes, provide copy of HOA 's documents .

HOA Name: ______________________________________________________________________________

How many stairs do you have? ________________________________

How far do you live from a busy street? _________________________

LIFESTYLE

Will the dog’s main living area be inside or outside?___________

On an average day, how many hours will dog be left alone? ___________________________

When left alone, where will the dog be kept?

Inside the home Y ____N____ In a crate Y _____N______ Crate dimensions__________________________

Contained to what room(s) if any?_____________________________________________________

What rooms will be off limits to the dog? _______________________________________________

Do you have a doggy door? Y______N_____

What areas outside are available to the dog? Yard_________ Chain link fence/height _________

Wood fence/height ______________ Block wall/ height____________

Does fence completely enclose the yard? __________

Could a dog escape your yard? ___________________

How many gates/ height? ______________ Invisible fence_______________

Kennel dimensions _______________________ Covered? Y_____N____
Will the dog ever be tied out for any reason? ___________________________

Enclosed Patio ____ Garage _____ Balcony ____ Dog House ____

Do you have a pool? Y_____N_____ is it gated? Y_____N____

If you are not fenced, how do you plan to potty and exercise your dog? _______________________

Where will the dog spend the night? ___________________________

When on vacation, who will care for the dog? ______________________________________

Pet sitter visit at home______ Boarding facility_________ Family / Friends home__________

What would happen to the dog if you have to move locally, out of state or even out of the county?
______________________________________________________________________________

______________________________________________________________________________

PET EXPERIENCE:

How would you rate your level of dog experience: First time owner _____ Intermediate _____ Advanced _____

If any children, rate their level of dog experience: First time owner _____ Intermediate _____ Advanced _____

Other___________________________________________________________________________________

What are your primary reasons for wanting a dog? Companion for you ____For children _____

Companion for other pet _____ Watchdog ___ Other ___________________________________

Below list the dogs you have now or have owned in the last ten years and explain what happened to each of them

Name Breed Age Sex F/M Spay/Neutered length of ownership What happen

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

Do you own any cats? _____ How are they with dogs?________________​

Do you own any other animals? ________________________________

Have you ever allowed an animal to breed? Y____ N_____ . How many litters?____________

Have you ever given a pet away? Y____N____ If yes, explain why ______________________

___________________________________________________________________________________

___________________________________________________________________________________
Where did your pet go?________________________________________________________

Which of the following reasons might prompt you to give up your dog?

Excessive barking ___ Digging ___Biting ____ Shedding ____ Poor watchdog___ Accidents indoors ____

Destructive chewing ___ Growling at guests _____ Aggressive on leash___ Health problems/expense____

Moving ____Divorce ____ Financial Problems ____ Allergies ____ Not getting along with other pets______

New spouse/partner doesn’t like dog___________ Other________________________________

None of the above_________

PET CARE AND WELL BEING:

Pets are an investment of time and money. Can you offer the cost of medical care, grooming, proper diet, shelter and exercise for your new pet? Y____N____

Do you agree to never transport your dog in the open bed of a pick-up truck? Y___ N___

Do you agree to a home visit by a UBS volunteer? Y____ N____

Dogs can live as long as 20 years. Will you make a long-term commitment for the dog’s entire life span? Y_ N_

Preferred level of exercise with dog? Couch potato ___Short walks ___ Vigorous walks ____

How do you normally walk your dog? On leash ____ Off leash ____

When on leash will you use? Collar only ___Choke chain ____Harness ____Other ___

Would the dog wear a collar at all times? Y___N___

How would you train your dog? Obedience class ___ verbal commands _____ Hand signals_____ Clicker _____ Shock collar_______ Other___________________________________________________________

How would you discipline your dog for misbehaving, give examples _________________________________

_______________________________________________________________________________________

Understanding that the going rate of training sessions run approx. $150 per session, would you agree to consult and pay for a trainer or behaviorist if any problems develop? Y____N___

Who will be the dog’s main caregiver (grooming, feeding, and exercise)_______________________________

_________________________________________________________________age(s) _________________





PLEASE READ AND INITIAL EACH STATEMENT BELOW:

The rescuer reserves the right to refuse adoption to any applicant for any reason.

This questionnaire becomes part of our contract. ______initial

I understand that a home visit is REQUIRED prior to final placement. _____initial

I understand that a home visit DOES NOT guarantee placement. _____initial

Walking dogs off leash will put the dog in unnecessary danger. I understand that my dog must be under my control at all times, and will abide by local and state ordinances regarding leash laws.____ Initial

If you adopt a dog from Useless Bay Sanctuary, and your dog goes missing for any reason, you agree to contact Useless Bay Sanctuary immediately so we can help recover the dog quickly. Dog owners can take simple measures to prevent losing a dog and to facilitate a speedy recovery if a dog is lost (described in a separate document). I agree to read these tips and implement them to the best of my ability. _____initial

If for ANY REASON, I am no longer able to provide a home to the dog adopted through Useless Bay Sanctuary, I shall immediately notify them of the situation and, with their approval, either place the dog in a home approved by Useless Bay Sanctuary or return the dog to the possession Useless Bay Sanctuary. _____initial

I understand that any monetary donation/contribution is a gift given freely, not a purchase price of dog. ____Initial.

Useless Bay Sanctuary asks for a minimum donation of $300. _______ Initial

I would like to make an additional donation of $___________ to help rescue, provide medical care, spay and neuter, board and place other abandoned dogs. ________ Initial

All the information I have given above is true and complete. Useless Bay Sanctuary has my/our permission to contact individuals and/or businesses I have listed in the above responses. Should an unspayed or unneutered dog be placed with me, I agree to have it spayed or neutered within one (1) month of adoption or by a date agreed upon by me and Useless Bay Sanctuary. This dog will reside in my home as a pet. It is solely my responsibility to provide adequate food, water, shelter, training, affection, safety and medical care. I understand that Useless Bay Sanctuary is a rescue/referral service and is not responsible for the accuracy of information received about temperament, habits, or physical condition of the dogs available for adoption. I understand that it is my responsibility to see and evaluate the dog for myself before agreeing to adopt it. I am in full agreement with these terms of adoption. Useless Bay Sanctuary is in no way liable or responsible for any damage, accident or injury resulting from the placement of a dog into my household and I/we agree to indemnify and hold harmless Useless Bay Sanctuary and its’ officers, members, and/or agents from any claims for damages arising from actions of a dog adopted by me/us. I/we also understand that my/our dog will be micro chipped prior to adoption and that Useless Bay Sanctuary shall remain as “alternate contact” through the micro chipping service. I agree to allow a UBS representative to examine the dog and his/her living conditions, at any time if they have a reasonable belief that the dog is not being cared for in a proper manner. If the dog’s living conditions are deemed unacceptable or if I have violated the Adoption Contract in any way, I agree to immediately surrender the dog to a UBS representative.



Signature___________________________________ Date__________________________________

Signature___________________________________ Date__________________________________