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The Central Rescue & Rehab adoption fee is $200 for adults and $250 for dogs under the age of six months.

General Information. The fields with an * after them are required.
First Name:*
Last Name:*
Street Address:*
City:* State:* Zip Code:*
Your email address:*
Primary phone:* Alternate Phone:
How did you hear about us? (check all that apply)



, please explain
Your age:* years
How many adults (over 18) are there in your household?*
How many children live in your household or visit regularly?* Ages:
Do you own your home or rent?*



If you rent, do you have permission from your landlord to have a dog?


Your answers to this survey will help us determine the best dog for your lifestyle.
Which dog would you like to adopt?*
Would this be your first dog?*



If no, please tell us what you like the most and least about dog ownership
What characteristics in a dog are most important to you? *
How many hours, each day, will the dog be without human companionship?* hours Please explain:*
Will the dog live inside with your family?*



If no, please explain.
Do you have any other pets at home? *



If you currently have a pet, how will he/she respond to a new dog?
Have you ever had to give up a dog?*



Do you have a completely fenced in yard?*



If necessary, would you be willing to crate train your dog? (we may recommend crate training on a case-by-case basis)*




Please complete the following section if you currently own a dog.
Are all of your dogs spayed or neutered?



If no, please explain your decision not to alter.
Are all of your dogs current on their rabies vaccination?



If no, please explain.

References: Please include your veterinarian's contact information. Leave blank if you have no vet.
Veterinarian:

Name:
Phone:
Email:




Comments
Please feel to provide any additional comments.

Adoption Terms of Agreement
Please check to signify your agreement to each of the terms stated below. All are required to submit your survey.


Reference checks: I give representatives of Central Rescue & Rehab permission to contact my veterinarian, landlord, references, or other rescue groups/humane societies for information to aid in the evaluation of whether a Central Rescue & Rehab dog is appropriate for me. 
Adoption Fee: The Central Rescue & Rehab adoption fee is non-refundable.

 

 

Medical:I understand that the dog has been given certain basic inoculations.  In addition, he/she made have had other medical treatment for issues that Central Rescue & Rehab is aware of. The dog I am adopting is accepted by me “as is.” I agree to provide yearly checkups, as well as required vaccinations, heartworm prevention, and basic medical care as needed. I understand that Central Rescue & Rehab makes no representations or warranties regarding the current or future medical condition of the dog and is not responsible for additional medical care for the dog. While most dogs are neutered or spayed prior to adoption, if I have adopted a dog that has not been neutered or spayed, I agree to have the dog spayed or neutered within 60 days and will send a copy of a certificate to that effect to Central Rescue & Rehab, P.O. Box 79, Wales, MA 01081..




Temperament: I understand that the dog has not been evaluated in a home setting and that Central Rescue & Rehab makes no representations or warranties regarding the dog’s behavior with adults, children, or other animals, nor provides other guarantees as to the dog’s characteristics, personality or training.  I understand and agree that Central Rescue & Rehab is not responsible for any injuries or property damage resulting from the possession or ownership of this dog. 




Care:   As this dog’s new owner, I agree to provide the training required to ensure a secure and respectful dog/owner relationship. I will not let the dog run free without supervision, be chained out all day or all night, be allowed around children under 14 years of age without adult supervision, be allowed to ride loose in the back of a truck, or remain unattended in any vehicle in extreme temperatures (over 70 degrees Fahrenheit).  I will license the dog in the town I live in and tag the dog for identification purposes.
Lost: I agree to promptly contact Central Rescue & Rehab if the dog is lost for more than 24 hours.





Adoption Termination: If for any reason the adoption is not satisfactory for the dog or adoptive owner, Central Rescue & Rehab requires that the dog be returned, at the adoptive owner’s expense, to Central Rescue & Rehab.  The dog may not be sold or given to a new owner without Central Rescue & Rehab prior written approval.  Central Rescue & Rehab reserves the right to take back this dog if it is ever neglected, abused or improperly cared for.  I agree to relinquish custody immediately upon request without the need for further legal writ or court order. 

The following will be completed at the time of the adoption

My signature below indicates that I am at least 21 years of age and intend to be the legal owner and the person responsible for the care and well being of any dog I adopt from Central Rescue & Rehab.

I, on behalf of myself and all persons resident in the household where _____________ [dog’s name] will reside, hereby accept possession of title to _____________ [dog’s name] and responsibility for the animal identified above and hereby release, indemnify and discharge Central Rescue & Rehab, and its directors, officers, employees and agents, forever from and against any liability for any injury or damage to any person or property caused in the future by this adoption, or by said dog, and from and against any causes of actions, suits or demands whatsoever that may arise as a result of such injury or damage. 

            ADOPTER                 Central Rescue & Rehab
Date:    _________________________________ Date: _____________________________
Name (please Print)_______________________ Name: ____________________________
Signature _______________________________ Signature: __________________________  

Submission

By clicking on submit, I agree that any misrepresentation of the facts in this application will invalidate the adoption agreement and give Central Rescue & Rehab the right to reclaim the dog without refund of the adoption fee.