Application – Help Rescue Arkansas

I understand that If I do not contact my vet and allow Help Rescue to speak with them about me, or if I do not fill this application out in a complete and detailed manner, this application will not be processed*

Dog or Puppy’s name:*

Color*

Breed*

Approximate Age*

Sterilized?*

Yes
No
Unsure

Adoption Fee

Your Name*

First Last

Home Address*

Street Address Address Line 2 City State ZIP Code

Home Phone*

Cell Phone

Email*

Are You Employeed?*

Occupation*

Work Address*

Street Address Address Line 2 City State ZIP Code

Work Phone Number*

Do you own your home?*

Yes
No

Do you have a fenced in yard?*

Yes
No

Are you willing to provide photos of your home?*

Yes
No

Please attach a photo of your home and family members living in the home

Max. file size: 25 MB.

Maximum combined file size is 25 MB, re-size pictures larger than this!

Picture #2

Max. file size: 25 MB.

Maximum combined file size is 25 MB, re-size pictures larger than this!

Picture #3

Max. file size: 25 MB.

Maximum combined file size is 25 MB, re-size pictures larger than this!

Have you ever been convicted of a Felony?*

Yes
No

If you have been convicted of a Felony please list your charges:

Please list any reasons you could foresee not being able to care for this dog for its entire life. (please write "N/A" if there are none)*

Please list ages of everyone in household*

Why do you want to adopt a dog?*

Do you have a Facebook page and how are you listed ?*

Have you owned a dog in the past, and where is that dog now?*

How will you train your dog?*

What will you do if your dog has a potty accident?*

Will you crate this dog/puppy? (If so please discuss this with one of our members so that we can guide you properly)*

Yes
No

Where will your dog sleep at night?*

How long will your dog be alone each day & where will they stay?*

If your dog is not spayed/neutered, how soon do you plan to make an appointment to sterilize your pet?*

Are you familiar with heartworms? Do you know what causes them, and are you willing to provide this dog/puppy with heartworm preventative?*

It is very important to us that your dog have some sort of identification on his/her collar. Would you be willing to purchase this ahead of time and bring it when you pick up your new dog?*

What activities will you do with your dog?*

How much time are you committed to walking and playing with your dog daily?*

Will you be willing to take your dog to obedience classes?*

What would make you rehome your dog?*

Where will your dog stay when you are on a trip?*

Please list age and gender of other pets in household*

There is a $100 non refundable deposit. If I decide that this dog does not fit well with my family, I will contact Help Rescue before rehoming.*

I understand that I am responsible for the care of this dog. I am responsible for any medical care that might be necessary once the dog/puppy is in my possession. I will provide annual vaccinations and heartworm preventative. I understand that if this puppy is not spayed/neutered, I will have it done before he/she is 6 months of age. I understand that intestinal parasites can reoccur in puppies and it is important to have a fecal exam done each time I take my puppy/dog to the vet.*

I agree to provide the dog with a collar and name tag with my phone number in case he/she gets lost. (PETS WILL BE TRANSPORTED WITH A TEMPORARY COLLAR AND TAG)*

I will not keep this dog crated over 6 hours at any time. I understand that crating an animal over 6 hours can cause this dog to be highly stressed and may in turn result in behavioral problems.*

I will not keep this dog on a chain or tied up in any fashion.*

I will not allow this dog to breed with another dog.*

I will not use this dog in any sort of dog fighting or as a bait dog/used to train fighting dogs.*

Help Rescue will not be held liable for any damages that this dog might cause including harm to a person or damages to property.*

I have read the information on the Alpha Dog Transport website (www.alphadogtransport.com) and understand that dogs are at risk for Kennel Cough when traveling together. I understand that transport guidelines are my future pet's medical records are in strict compliance with and that the dog/puppy I am adopting has had at least 2 rounds of vaccinations including one Bordatella Vaccine to prevent Kennel Cough. Help Rescue is not responsible for medical bills that occur once the puppy/dog has been picked up by the owner.*

I understand that transport fees are NON-REFUNDABLE*

I understand that the dog/puppy I am adopting may need additional shots/vetting. I am prepared to provide the required vaccinations and spay/neutering. If adopting an unsterilized puppy, I will have him/her spayed/neutered by the age of 6 months. TAKE THE MEDICAL RECORDS WITH YOUR PET TO THE APPT.*

I agree to ONLY use POSITIVE reinforcement to train this dog/puppy and will not at ANY TIME hit, strike, spank, kick, or use ANY physical means to discipline this dog/puppy. I will contact Help Rescue immediately with any behavioral issues regarding the dog/puppy, and agree to enlist professional assistance from a qualified dog trainer/handler if required to ensure this dog/puppy learns to live a balanced life. I understand that using my voice loudly and saying “NO” or using a spray bottle of water is an appropriate way to discipline, when IMMEDIATE correction is needed to train my dog/puppy. I understand that my dog/puppy will not understand any correction other than IMMEDIATE correction DURING inappropriate behavior training.*

I agree to watch stool of my new pet carefully the first week. A bit of “stress diarrhea” is not uncommon, due to the stress of transporting. Avoid table scraps and human food. Use only pet treats to reward good behavior! (I use dehydrated chicken treats.) Give lots of praise and a treat when your new pet uses the pee pad or the appropriate outdoor location when house training!*

I acknowledge that in the past, on a few occasions, we have sent puppies to their forever homes that have tested positive for heartworms several months after being transported. It is beyond our ability to know this before 6 months of age. We take every precaution to prevent this. However some puppies that come in to the rescue have been in deplorable conditions. We do our best to ensure the health and safety of every dog and puppy we adopt.*

I agree to contact Help Rescue within 24 hours of picking the dog/puppy up from transport, to ensure that the dog/puppy is in the new owners care and is healthy and safe. Please call or text 870-318-4161. By signing/typing this contract, I am in agreement to ALL of the statements listed above*

I agree that before euthanizing this animal for non-medical or behavioral issues I will contact Help Rescue and give them the option to reclaim the animal prior to euthanizing.

Sign full name agreeing to the above paragraph*

YOU MUST CALL YOUR VETERINARIAN AND GIVE PERMISSION FOR THEM TO SPEAK TO US, IF YOU DO NOT CURRENTLY HAVE A VETERINARIAN YOU WILL NEED TO GIVE US THE NAMES, PHONE NUMBERS AND RELATIONSHIP OF TWO PERSONAL REFERENCES. (IF YOU DO NOT NOTIFY YOUR VET TO SPEAK WITH US WE WILL NOT BE ABLE TO PROCEED WITH THE APPLICATION)

Veterinarian/Reference #1*

Reference #2

Only needed if you are not listing Veterinarian

Please look on Alpha Dog transport ( www.alphadogtransport.com ) and review the process of transporting your new dog to you. You will need to go to the website, click “Our Stops”, scroll to Saturday and find your closest pick-up location. You will not make the reservation. I will do that for you. Transport Cell phone (Jeff & Kevin) 774-641-3790

Where will you pick your new dog/puppy up from?*

Please feel free to ask for any references. Our board has been involved in Dog Rescue collectively, for many years, and we work very hard to maintain an excellent reputation. We welcome any questions and will be glad to talk to you at any time during this process. We feel adopting a dog is an extremely serious commitment.

FOR CONNECTICUT ADOPTERS: PLEASE BE SURE TO READ THE NEW STATE RULES BELOW FOR ADOPTING AN ANIMAL! You must comply with the new Connecticut Importation Law, CT Public Act No. 11-187. For review of the CT Substitute House Bill No. 5368, Public Act No. 11-187 please visit: http://www.cga.ct.gov/2011/ACT/PA/2011PA-00187-R00HB-05368-PA.htm Dogs/puppies adopted in CT must be seen by a vet within 2 days of adoption.

By signing this I fully understand and agree with all terms*

Date*

After hitting the submit button on this application, you must wait for the message verifying that your application has been submitted. If you leave the page before you get a verification, your application will be lost and you will have to fill it out again. Once the application is submitted, you will recieve a copy of your application at the email you listed in the application. If you are having any issues with this application or attaching pictures contact adoptions@helprescuear.org.*