Nova

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Nova is a healthy, energetic, six year old Boxer mix who is intelligent and loves to play. She is spayed, about 75 pounds, and up to date on all health care. Nova is house trained, crate trained, walks on a leash, gets along well with other dogs and cats. She is fun, engaging, and needs only acclimating, not training, to be a wonderful family member. Adoption fee $50. NK

Nova is located in Western North Carolina. Optional transport is available weekly. If your application is approved, we will contact you regarding cost and delivery if you wish to transport the pet to your location for a cost.

To adopt Nova, please submit this adoption application.

RCHS Dog Adoption Application

Welcome to Rutherford County Humane Society’s dog adoption program. We request the following information so that we can assist you in the selection of a new dog. This form and a consultation with a Rutherford County Humane Society representative are designed to help you find the dog most compatible with your lifestyle.
This is a multi page form. Please complete each page before clicking “Next” to proceed to the next page. When you complete all five pages and the form is submitted, you will receive an email with a printable PDF of your completed form. We will get back to you ASAP. If you need to stop and come back to the form later, click ‘Save and Continue’ A link will be provided for you to return and complete this form from any computer.

1Applicant Information

2Home Environment

3Your Plans For this pet

4References

5Submit Application

Date

MM slash DD slash YYYY

Dog's Name:(Required)

Gender preference(Required)

Male

Female

Any

I am aware that all of our pets are located in Western North Carolina, but that transport is available for a cost.(Required)

Yes

Applicant's Name(Required)

First Last

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Email(Required)

Contact Phone Number(Required)

Applicants Age(Required)

Must be Be 21 years of age or older

Applicant's Occupation(Required)

Employer

Name

Address

Phone

Adults and children living in this household.

Click plus sign on right to add extra rows.

Name

Age

Occupation

What other dogs/cats currently live in your home:

Click plus sign on right to add extra rows.

Name

Age

Breed

Sex

Spayed/neutered

Health Issues

What other dogs/cats have you previously owned and what happened to them?

Click plus sign on right to add extra rows.

Name

Age

Spayed/neutered

Reason for giving up/cause of death

Are there any other types of animals currently living in your home?

(if so, describe):

What do you know about the breed in question?(Required)

(It is required that you research this breeds traits/habits)

Are there any specific habits/problems you are not willing to work with?(Required)

If so, please specify:

What kind of housing do you live in?(Required)

House

Apartment

Mobile Home

Does anyone in your family have allergies to ANY animal?

Yes

How long have you lived at this address?:(Required)

Residence Ownership(Required)

Rent

Own

Landlord

Name

Address

Phone

If you rent, do you have permission from your landlord to own a companion animal?

Yes

What sized pet is allowed?

Under 26 lbs

Over 25 Lbs

Do you have a fenced-in yard?(Required)

Entire yard

Front yard only

Backyard

Attached to back door

None

Other

Do you have a Pet door, Kennel run, Dog house, Stake, Tie-out or cable-run,Crate, or None.

Please describe:

How will the animal be exercised and allowed to eliminate?(Required)

Do you have a swimming pool?

Yes

Is it fenced-in separately from the rest of the yard?

Yes

What member of the family will be taking the MAJOR responsibility for the care of this animal?

What are your plans for this animal?

Please describe:

Protection/guard

Companion

Childs pet

Pet therapy

Agility/fly ball

Obedience

Herding

Ranch work

Other

Are you planning on taking your adopted dog to an obedience class?

Yes

Have you ever sold, given away or surrendered a pet? If so, please provide details of situation:(Required)

How much time are you willing to give the dog to adjust to its new environment and family members?

Will the animal live in the home? If not, where will it live?:

This dog may not be house-trained. Are you willing to take the time to work with the animal?(Required)

Yes

Where, exactly, will the animal sleep at night and be kept when there is no one at home

(i.e.., crated, free roam of home, laundry/kitchen area, fenced-in yard, etc):

On the average, how long will the animal be left alone during the day?

Do you believe in dog crates? If so, for what exact purpose(s)?

If you had to move and your new landowner does not allow pets, what will you do with your companion animal?

Under what condition(s) would you consider giving up your companion animal?

Your Veterinarian's Name(Required)

First Last

What is the Veterinarian Clinic Phone Number?(Required)

What is your veterinarian's address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

What type of Heartworm Prevention do you use?

Are you willing to allow an RCHS representative to periodically visit your home?

If not, why?

Reference #1(Required)

Please provide name, address, phone number & email address of NON-RELATED personal references, whom you have known for at least 3 years, and who may be familiar with your pet ownership history.

Name

Address

Phone

Reference #2(Required)

Please provide name, address, phone number & email address of NON-RELATED personal references, whom you have known for at least 3 years, and who may be familiar with your pet ownership history.

Name

Address

Phone

Reference #3(Required)

Please provide name, address, phone number & email address of NON-RELATED personal references, whom you have known for at least 3 years, and who may be familiar with your pet ownership history.

Name

Address

Phone

What arrangements have you made for your companion animal(s), if you could no longer care for them (i.e.., moving overseas, extended hospital stay, nursing care facility, death)?

And, finally, please tell us a little about yourself and why you feel you could provide a good home for a rescued companion animal:(Required)

Consent(Required)

****Our goal in rescuing and re-homing animals is to provide them with a loving home for the rest of their lives. Most of RCHS’s dogs are in foster care in Rutherford Co, NC. The adoption fee covers all or a portion of the medical care and daily expenses while your dog is in our care.
All animals adopted by our group MUST BE spayed/neutered prior to finalizing the placement. (Question: Does this mean the adoption isn’t final until spayed/neutered if puppies? Not sure we want to address this here since it’s on our contract. This is confusing for puppies. But we can discuss.)
Your signature below states that you understand any future medical costs are your responsibility and we have made full disclosure regarding our and our vet’s knowledge of the health of the animal.
Sometimes, for reasons beyond anyone’s control, the adoption does not work out. In this case, the animal must be returned to RUTHERFORD COUNTY HUMANE SOCIETY (RCHS) at the adopter’s expense, although RCHS will try to arrange a rendezvous with the transport company to minimize the adopter’s inconvenience. Adoption fees may be refundable, at the discretion of RCHS.
By signing this application, I attest to the fact that I am 21 years of age or older, and that the above information provided is correct. RCHS and adopter agree to accept typed in names (electronic signatures acknowledging approval of this agreement), to be the equivalent of actual signatures of the parties.

I agree to RCHS conditions.

Signature(Required)

Spouse/Partner Signature

Phone

This field is for validation purposes and should be left unchanged.

Nova

To adopt Nova, please submit this adoption application.

RCHS Dog Adoption Application

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