Adoption Form

Big Heart Rescue Society
PO Box 6, Gabriola BC V0R 1X0
604-583-DOGS(3647) spiritsmission@shaw.ca

ADOPTION APPLICATION

Please Note: You must complete the entire application.
Incomplete applications will be denied.

Personal Information
Application Date:
Name of the Companion You Want to Adopt:
Your Name(s):
Address:
City:
Province:
Postal Code:
Phone (Home):
Phone (Cell):
eMail Address:

Employer 1: Name:
Your Job/Occupation:
Work Phone:

Employer 2: Name:
Your Job/ Occupation:
Work Phone:

Your Age:

Tell Us About You and Your Home
Why do you want to adopt?
Describe your current companion animals:
Are all your companions sterilized?		Yes No
How do your current companions interact with other animals?
Who is your veterinarian?
Are your companions' vaccinations up to date?		Yes No
Do your companions have annual checkups?		Yes No
Do you have children age 17 or younger living at home?		Yes No
What is their experience with dogs?
Which family member(s) would be responsible for the care of this companion?
Please describe your home in detail (house, townhouse, apartment, etc)
Please describe your yard in detail (fenced, type, height, size of yard, etc)
Do you own or rent your home? (If you rent we will require a copy of the rental agreement stating that dogs are pemitted)		Own Rent

About Your New Companion
How will your new companion be exercised (for how long and where)?
Where will your new companion sleep at night?
Where will your new companion stay during the day when you are at home?
Where will your new companion stay during the day when you are NOT at home?
How many hours per day will the companion be left alone?

Training Your New Companion
Please describe your plans for training this new companion
Describe how you deal with a dog displaying behavioural issues
What are you expecting regarding a dog's obedience training when it first arrives at your home?
If the companion was on the couch and refused to listen to the Off command, what would you do?
If you returned home to find the companion had urinated on the carpet or chewed a shoe, what would you do?
What is your philosophy regarding crate training?
Briefly describe the perfect dog for you. What characteristics are you looking for? Think about your lifestyle - are you active, in and out of the home, lots of people or children around or are you a quiet sedentary person with few visitors? What personality would best fit your family's needs and lifestyle?
Of the characteristics you listed immediately above, which 2 are the most important?

References
Reference 1: Name
Address:
City:
Province:
Postal Code:
Phone (Day):
Phone (Evening):

Reference 2: Name
Address:
City:
Province:
Postal Code:
Phone (Day):
Phone (Evening):

Reference 3: Name
Address:
City:
Province:
Postal Code:
Phone (Day):
Phone (Evening):

Final Details
The basic needs of a healthy companion (feeding, vet visits, etc) can cost about $500 to $800 per year. Health or behavioural problems can increase this. Does this financial responsibility present a problem?		Yes No
Have you applied anywhere else within the past year to adopt an animal?		Yes No
If yes, please state name of agency, rescue, pound etc and when
Are you prepared to allow a representative from Big Heart Rescue to conduct a home visit before and after the adoption has been completed?		Yes No
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 companion I (we) adopt from Big Heart Rescue Society of BC. In completing this application, I give representatives from Big Heart Rescue permission to contact my veterinarian, references and landlord if applicable. By completing this document, I give Big Heart Rescue of BC the right to check with other rescue organizations, humane societies, or my vet and/or to share information about my application with said other groups or with my vet. By completing this document I understand that Big Heart Rescue Society of BC has the right to refuse my application, if the application or home situation is deemed not to be a match for the companion applied for. I also understand that any misrepresentation of the true facts in this application or in the adoption contract will invalidate the adoption contract and will give Big Heart Rescue Society of BC the right to reclaim the adopted companion without refund of the adoption donation. My name below indicates that I understand these Terms of Adoption and agree to abide by them if I adopt a companion through Big Heart Rescue Society.
Completed by (name):
Date:
We would appreciate any other comments you have regarding this adoption:
If you want a copy of the completed form, please PRINT IT NOW before you click the Submit button