ADOPTION APPLICATION
You may print out and return completed application to:
18 shades of Grey
Fax 409-769-9249
Or by e-mail:
rjergenson@eighteenshadesofgrey.comPlease print clearly. Must be 18 years of age, to adopt a Pet from 18 Shades of Grey (If under 18 years of age, must be filled out by legal guardian). All family Members of the Household must be in agreement to the Adoption of a New Pet.
DATE:
YOUR NAME:
Name of the animal in which you are interested:
Breed/Description: Male/Female
Release for Veterinary Reference: (to be completed by potential adopter)
I (your name) ____________________________________ hereby give permission for any veterinarian that has provided service to me, for pets owned or past owned, to release medical information on any/all of my animals to 18 SHADES OF GREY
Signature Date
Current veterinarian is:
Contact #
Address (include City and Zip Code
________________________________________________________________________
YOUR PERSONAL INFORMATION:
Home address: City/state/zip
Home phone Work phone
Cell phone
EMAIL:
What is the best time we may call you?
Spouse/Partner Work or cell phone
~OR~ Other Family Member (if no spouse)
How long would the pet be left alone?
Where would the pet stay during this time?
Do you or your spouse/partner travel frequently? Yes No
How often and/or length of time on trips?
What will you do with the pet when you travel?
What will you do with this pet if you have to move?
Are you able to purchase, and use a dog crate if advised? Yes No
Do you have a pet door? Yes No How would you handle the dog’s potty needs?
Have you house-trained an animal before? Yes No
If so, describe what method you used to house-train?
How would you exercise the pet?
Where would the pet sleep?
Do you live alone or with family?
Does every adult in the household agree on owning this pet? Yes No
Does anyone in the household have allergies? Yes No
If so, are they allergic to animal dander?
Children/grandchildren? What ages?
Do they live in the household? Yes No
If they do not live with you, how often do they visit?
Are you willing and able to commit to behavior and/or dog obedience training? Yes No
Do you own or rent? House? Apartment?
How long have you lived at this residence?
If renting, is there a pet deposit required? Yes No
Have you already provided this payment to rental office? Yes No
Please provide 18 Shades of Grey copy of proof/receipt of pet deposit paid OR
Your Rental manager’s contact information, for verification of pet deposit
Contact name_ Phone#_
Have a fenced yard? Yes No What type of fence and how high?
Do you have an in-ground swimming pool? Yes No
Fencing around the Pool? Yes No
Have you ever applied to adopt an animal, and been declined? Yes No
If so, why?
What qualities are you looking for in a pet? (Please be specific
What traits or characteristics are you sure you do NOT want?
Do you give permission for an 18 Shades of Grey representative to visit your home prior to adoption, to do a home check and, after adoption, to do follow-up checkup on this newly adopted pet?
Yes No ___________ Initials
PET OWNERSHIP HISTORY
Do you or did you have other pets?
Please state the breed, gender, of each pet. Include whether Pet was spay/neutered?
On heart worm prevention medication?
How and when was pet acquired?
If the pet is no longer with you, how long have you been without a pet?
If necessary, attach another sheet or write on the back.
Did this pet have any problems, behavior issues, or health conditions?
What happened to this pet?
What kind of Heartworm preventative?
When last given (M/D/Y)?
Date of last shots: DHLPP, Bordatella and Rabies (M/D/Y)?
______________________________________________________________________
ADOPTION AGREEMENTS
• Agree the adoption fee to be ~NON-REFUNDABLE DONATION~ of $225.00 which 18 SHADES OF GREY utilizes to pay vetting and other expenses. Even if you return this adopted pet back to 18 SHADES OF GREY, we are not able to refund. _____________Initials
• 18 SHADES OF GREY now offers microchipping for a fee of $25.00 ___________Initials
• Agree that this adopted companion pet from 18 SHADES OF GREY will never be sold, traded, OR dumped. Adopter/new owner will never relinquish this pet to any city dog pound. If Adopter/new owner is unable to keep adopted pet it will be immediately returned to 18 SHADES OF GREY. ___________Initials
• Agree that all future medical and health maintenance treatments are the sole financial responsibility of the new adopters/owners. Agree to administer regularly prescribed heartworm preventatives for your adoptive pet, (all year round). If the dog is heartworm positive, I understand that Heartgard® is the only preventative treatment that may be administered. Any other type of heartworm treatment or preventative could cause the dog to become seriously ill or even die. ___________ Initials
• Adoption of a new companion pet is to be frequently indoors, interacting with the family. And not to be a banished pet(s) to the back yard. Will never tie out the pet to a chain, or rope leaving him/her in the back yard permanently. Nor Leave him/her unattended for long periods _____________ Initials
• Will protect this pet with annual vaccinations and routine medical care and Health
Maintenance as recommended by a veterinarian. Will seek immediate veterinary care at time of injury or signs of illness. __________Initials
• Agree that the dog SHALL NOT be physically altered in any manner (docking tails,
Cropping ears, de-barking, or any other kinds of unnecessary cosmetic procedures. ____________Initials
• Will comply with all state and local county ordinances in regards to proper, pet ownership responsibilities, Obtaining, the needed veterinary care, and licensing of adopted pet per the statues of county/city/state of companion pet. Will reclaim this pet
Promptly, and pay any required fees, if it is picked up by an animal control agency. Rabies
And ID tags will be kept on the animal at all times. __________Initials
I understand that 18 Shades of Grey does not make any guarantees
Regarding the age, nature, temperament, or health of this pet, Although 18 Shades of Grey does take all precautions in assessing rescued dogs, along with Professional veterinarian visits for all health needs of each and every animal; there is Always a chance or risk in adopting a new pet, in which may not be seen by veterinary or rescuers during the animals time in foster or vetting visits. ) __________Initials
Understand adopter/new owner to assume all risk and responsibility of ownership of this pet once he/she is in adopter/new owner’s possession. Agreeing to defend, indemnify, and hold harmless 18 Shades of Grey, and its agents, against any and all claims including claims of Property damage and/or personal injury, which arise from adoption of this pet.________ Initial
Failure to fully and timely comply with the terms of this contract, will voluntarily and immediately release ownership, possession, custody and control of this pet to 18 Shades of Grey and if failed to do so, 18 Shades of Grey will be entitled to enforce specific performance of this contract in addition to any other legal remedy available to 18 Shades of Grey.__________Initial
Affirm that all information in the application is true, complete and correct and agree that
Any false or misleading statement thereon will constitute a breach of this contract. ________Initial
Special provisions of this contract, if any, are as follows: _____________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
_____________ Initial
If you have any questions, you may contact 18 Shades of Grey at 409-767-1494
I, (your full name) ____________________________________________________ have fully read and fully agree to abide by and honor this contract between myself and 18 Shades of Grey I further agree that the pet which I am adopting will not be released to my custody until the adoption fee is paid in full directly to 18 Shades of Grey or if instructed to be paid to the veterinary directly that provided the medical requirements & needs of this animal.
_______________________________________________ _____________________
Signature Date
SPECIAL NOTE: 18 SHADES OF GREY is a non-profit foster, transportation & placement service for retired racing
Greyhounds. Veterinary care and Transporting is a very high cost expense when caring for several hundred animals a year. The adoption fees do not cover travel expenses of animals. Additional funding will be required if you wish to adopt a pet from 18 SHADES OF GREY from out of the state of Texas.