Applicant Name
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First Name
Last Name
Birthdate
*
MM
DD
YYYY
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Cell Phone
(###)
###
####
Home Phone
(###)
###
####
Email Address
*
Name of pet(s) you wish to adopt
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Have you personally owned a dog within the last 5 years? What type of dog?
Do you own your home? How long have you lived there?
If you own, are you able to provide documentation proving home ownership?
*
Do you belong to a tenant's association or a homeowner's association?
*
Would your pet(s) go with you if you moved?
Are you planning on moving in the next six months?
How many adults are in your household?
None
One
Two
Three
Four
Five
Six
Please list your occupation and the occupation of all adults living in your home:
How many children are in your household?
None
One
Two
Three
Four
Five
Six
What is the age of the youngest child living in your home?
None
1-5
6-10
11-13
13-16
17+
Please list the full name, date of birth, and relation to all adults living in your home. Please list the exact ages of all children living full or part time in your home.
What pets do you currently have in your household?
Please list pet(s) name(s), age(s) and if they are neutered/spayed
Please list names and ages of pets owned in the last five years, that are not currently in your household
Please describe any specific characteristics you are looking for in a pet:
Are you on active military duty or other job subject to relocation?
Realistically, what would happen to your pet(s) if you were relocated?
Are you at least 25 years of age? BARC CT does not adopt to anyone under the age of 25.
If your family changed (marriage, divorce, new baby), would you keep your pet(s)? Who will be the primary caretaker and what would you do to help your dog adjust to the changes?
How will you help your current pet(s) adjust to your new pet(s)?
Name and phone number of three references (not related to you)
Name/address/phone number of your veterinary hospital
What emergency veterinary hospital do/would you use?
Are you willing to provide annual vaccinations and any medical care necessary?
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Where will you keep your pet(s) during the day and at night?
Where will your pet(s) sleep?
How long will your pet spend alone each day?
Will you let your pet(s) outside?
How will you keep your pet from roaming?
How would you handle a dog that starts to bark a lot?
How will you care for your pet when you travel, go on vacation, or in case of emergency requiring your extended absence?
If your pet(s) gets lost, what steps would you take to find him/her?
Please acknowledge that you and every member of your household has thoroughly read and understands BARC CT's Two Week Decompression and if your are approved to adopt, you agree to follow the instructions fully and without modification.
*
I acknowledge and agree that BRIDGEPORT ANIMAL RESCUE CREW, INC. (BARC CT) cannot guarantee me or anyone else what type of temperament the animal(s) I am fostering may have, that I am not an agent of BARC CT, and that I hereby accept responsibility for the animal(s) in my care. My ability to adopt an animal from BARC CT is often contingent on a satisfactory home visit. I understand that if I am chosen to adopt an animal, I have an obligation to provide proper care for the animal. Release and Waiver of Liability: In Consideration of being permitted to adopt an animal from BARC CT, EACH OF THE UNDERSIGNED, for himself/herself, his personal representative, heirs, next of kin, invitees, and/or guests: 1. Acknowledges, agrees, and represents that he/she is aware of and assumes the many risks associated with being around animals, including but not limited to the risks of being bitten scratched, jumped upon, knocked over, chased, tripped, infected with a disease, or otherwise injured or frightened, as well as the risks of damage to personal property and that the BARC CT cannot guarantee me or anyone else what type of temperament the animal(s) I am adopting may have, and that I am not an agent of BARC CT, and that I hereby accept responsibility for the animal(s) in my care. 2. HEREBY RELEASES, WAIVES, DISCHARGES, and COVENANTS NOT TO SUE BRIDGEPORT ANIMAL RESCUE CREW, INC. (BARC CT), its volunteers, employees, agents, members, directors, officers, or any affiliated entities thereof, FROM ALL LIABILITY TO THE UNDERSIGNED, his personal representative, assigns, heirs, next of kin, guests, and/or invitees FOR ANY AND ALL LOSS OR DAMAGE, AND ANY CLAIM OR DEMANDS THEREFORE ON ACCOUNT OF INJURY TO THE PERSON OR PROPERTY OR RESULTING IN DEATH OF THE UNDERSIGNED OR ANYONE ELSE ARISING OUT OF OR RELATED TO THE ADOPTING OF AN ANIMAL FROM BARC CT. 3. HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS BRIDGEPORT ANIMAL RESCUE CREW, INC (BARC CT), its volunteers, employees, agents, members, directors, officers, or any affiliated entities thereof, from ANY LOSS, LIABILITY, DAMAGE, OR COST INCLUDING BODILY INJURY OR PROPERTY DAMAGE ARISING OUT OF OR RELATED TO THE FOSTERING OF AN ANIMAL FROM BARC CT. 4. HEREBY ASSUMES FULL RESPONSIBILITY FOR ANY RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE ARISING OUT OF OR RELATED TO THE ADOPTING OF AN ANIMAL FROM BRIDGEPORT ANIMAL RESCUE CREW, INC. (BARC CT). 5. HEREBY agrees that this Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement extends to all acts of negligence by BRIDGEPORT ANIMAL RESCUE CREW, INC. (BARC CT), its volunteers, employees, agents, members, directors, officers, or any affiliated entities thereof, and is intended to be as broad and inclusive as is permitted by the laws of Connecticut and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. I HAVE READ THIS ADOPTION APPLICATION AND/OR CONTRACT, RELEASE, AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.
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Please Initial that you agree.
I understand that every dog benefits from professional training and behavioral modification, by printing my name below, I am agreeing that if any new changes occur in my life (i.e.; a new baby, moving, a change in daily life for any reason) or I simply notice an undesirable change in my adopted dog's behavior at any point, I will immediately hire a professional to evaluate my dog and purchase training, regardless of costs involved, if deemed necessary. I understand that no "returns" will be permitted until I, as a responsible dog owner, have sought professional training and veterinary care for my dog. Please print your name as a legal signature *
***120 DAY RETURN POLICY: After exhausting all reasonable methods of intervention, should I still choose to no longer want to keep my dog for any reason whatsoever, I understand I am obligated to notify BARC CT IN WRITING VIA EMAIL. I understand I am LEGALLY responsible to keep my adopted dog/animal safe and sound, in my care by any means necessary, or placed in a reputable boarding facility for which I am responsible for all costs until an appropriate replacement foster or adoptive home can be located by BARC CT. While BARC CT volunteers will make every effort to work quickly, I am aware that this process could take up to 120 days and BARC CT is NOT financially responsible until day 121 of the return process. I am aware that I am not permitted to rehome, give away, sell or surrender my adopted dog to a shelter, veterinarian, or another Rescue at any point of ownership through and including the 120 days of the required hold for returns. Print Name
*
I agree that BARC CT (d/b/a/ Bridgeport Animal Rescue Crew, Inc.) and any of its officers, board members, volunteers, affiliates and associates are in no way responsible for any degree of injury or damage while I am in contact (directly or indirectly) with any BARC CT animals whether an incident occurs on my property, public property or private property. I understand that interactions with any animal is potentially dangerous and there is always risk of injury or damage. By signing this form, I voluntarily choose waive any legal recourse with full knowledge that there is risk of personal injury, property damage and loss or death. I agree that neither I, my heirs, assigns or legal representatives will sue or make any other claims of any kind whatsoever against BARC CT CT (d/b/a/ Bridgeport Animal Rescue Crew, Inc.) and any of its officers, board members, volunteers, affiliates or associates for any personal injury, property damage/loss, or wrongful death, whether caused by negligence or otherwise. This statement includes the pursuance of animal seizure in the event that a BARC CT representative feels an animal is no longer safe in the home in which the animal was placed either temporarily by way of fostering or permanently by way of adoption. *I authorize my printed name to be considered legal signature. Please print full name.
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Signature
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Date of signature
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MM
DD
YYYY
