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 $250. _______ 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__________________________________
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 $250. _______ 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__________________________________