Southern Souls Rescue

Adoption Agreement

Applicant Name:

________________________ Date: ____________

Address: __________________________________________________
__________________________________________________
Home Phone: ______________

Cell Phone: ______________

Name of pet you are applying to adopt (if known): ________________

Breed: ______________

Approximate Age: ______

Sex: ______

Please answer the following questions truthfully and to the best of your
knowledge:
Why do you want a pet?
______________________________________________________________________
______________________________________________________________________

Are there children in the home? (Y/N) ____ How many? ___
List each childs name and age:

_______________________________________

____

_______________________________________

____

_______________________________________

____

What is your experience with pets in the past? Describe in detail.

______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
How extensive is your knowledge of this particular breed of dog?
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Are there any pet allergies in the home? (Y/N)

____

Does everyone in the household agree with this adoption? (Y/N) ____
Will the pet be kept mostly indoors or outdoors? __________________
If outdoors, what type of shelter will be provided? _________________
Where will the pet sleep? ______________________________________
How much time are you willing to allow the pet to adjust to his new home and family?
____________________________________________________________________

Would you consider taking obedience classes with the dog if there are any issues or
problems you cant address on your own? _____________

On average, how long will the dog be alone each day? ______________
How long have you owned current or past pets? ___________________
What happened to any past pets? _______________________________
___________________________________________________________
Do you currently have any pets? (Y/N) ____
If yes, please list name, breed, sex, and age of each animal below.
Name

Breed

Age

Sex

____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
Are all pets listed above currently up to date on vaccinations? Y/N ____
If no, please give a reason: ________________________________
Are all pets listed above currently spayed or neutered? Y/N ____
If no, please give a reason: ________________________________
Southern Souls Rescue recommends that all pets be microchipped and tagged with
identification at all times. Are you willing to have your pet microchipped? _____
If you are adopting a puppy or kitten that is not yet of safe age to be spayed or
neutered, you are required to have the animal spayed/neutered within ninety (90) days
from the date of adoption at your expense. __________

Please list your veterinarians information below.

Veterinarians name and/or practice:
Veterinarians address:

____________________________

_______________________________________
_______________________________________

Veterinarians phone number:

____________________________

* PLEASE NOTE: Southern Souls Rescue will contact the veterinarian you list to
confirm that your other pets are vaccinated, if applicable.*
Do you own your home or rent your home? ______________________
If renting, your landlord MUST approve the adoption. Please list contact information
below.
Landlords name: ____________________________________________
Landlords phone number:
Landlords address:

________________________

__________________________________________

Is your home completely fenced and secure? (Y/N)

_____

If yes, what type of fence do you have, and how high is it?
___________________________________________________________
If no, how do you plan to contain your dog in the yard?
___________________________________________________________
Please list 3 references other than your landlord or veterinarian:

Name

Phone Number

Relationship

Years known

________________________________________________________________
________________________________________________________________
________________________________________________________________

TERMS AND CONDITIONS OF AGREEMENT

By submitting this application, you agree that the addition of a family pet is an
important decision. You have thought through possible changes that may occur
in your life, and feel you would still be willing and able to care for this pet should
they occur. You understand your pets life span could reach 15 years or more,
and agree to care for him properly for the rest of his natural life. ________
(initial here to confirm)
You agree to take the adopted pet to your selected vet within 30 days, and at that
time provide proof of the vetting to Southern Souls Rescue (UNLESS it is
specified that the animal has had recent vetting, in which case YOU are
responsible for the next scheduled time of visit). A call will then be made to the
vet to verify the appointment. _________ (initial here to confirm)

You agree that if the pet is not vetted in a timely matter, or if for any reason the
adoption does not work out, you will return the dog to Southern Souls Rescue, at
YOUR expense, and you will NOT take the pet to a shelter. If the pet is returned to
us within fourteen days (14) from date of adoption, the adoption fee will be fully
refunded within fourteen (14) days if the pet comes back to us in the same or
better condition in which he was received. If you take the pet to a shelter, you
hereby agree to pay ANY and ALL legal costs that occur from doing so.
Furthermore, you will assume all legal fees Southern Souls Rescue may incur by
filing a suit against you for breach of contract, and filing a claim to have the dog

returned to us. You also agree to pay ALL fees that the pound will charge as a
result of you surrendering the animal to their facility. __________ (initial here to
confirm)
If for any reason we deem that this animal is not being properly cared for, you will
be required to return the dog/cat to us immediately at YOUR expense.
__________ (initial here to confirm)

NOTE: Southern Souls Rescue does not SELL pets. The fee for each dog
adopted is $175, which is used solely to recover a portion of the costs incurred
from this pet, and / or will go to aiding another rescue pet in need. The fee is
never close to what has been originally paid out to rescue and care for this pet.
This fee must be paid in full at the time of adoption. ___________ (initial here to
confirm)
Southern Souls Rescue does not condone chaining or otherwise tethering
unattended dogs. If we become aware that any animal you have adopted from
Southern Souls Rescue is being chained or tethered as a means of permanent
containment, we reserve the right to immediately repossess the animal and your
adoption fee will NOT be refunded. __________ (initial here to confirm)

Southern Souls Rescue makes every effort to ensure that the animal you are
adopting is healthy. We would never knowingly adopt an animal out without first
disclosing any known health problems. Any medical expenses incurred by you
after adopting the animal are the sole responsibility of the adopter, and Southern
Souls Rescue will not be held responsible for any veterinary bills after the
adoption has been finalized without prior consent, in writing, from Southern
Souls Rescue. __________ (initial here to confirm)

I HAVE READ AND AGREE TO ALL TERMS

AS LISTED IN THE CONTRACT ABOVE.

Adopter: (Please sign and date)

_____________________________________________________
Adopter: (Please sign and date)
_____________________________________________________
Southern Souls Rescue: (Please sign and date)
______________________________________________________

Thank you for making adoption your first option!

Southern Souls Rescue
www.southernsoulsrescue.org