The WTDR Adoption Form Name of Animal*Date* Date Format: MM slash DD slash YYYY Wiggly Tails Rep: ____________________________________ Adoption Fee: ____________________________________ PAID: Debit/Credit // CASH Coupon BL: Y // N PK Given: Y // NSummary of InterestPlease let us know about any traits you are looking for in your new pet.Did anyone refer you to WTDR?Name* First Last Second Applicant First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Email* Preferred Contact Method*EmailPhoneTextHow many adults live in the home?*Children?*YesNoChildren's Info and AgesResidence Type*HouseApartmentDuplexOtherResidence DescriptionDo you own or rent?*OwnRentDo you have permission for a dog?YesNoIs there a deposit required?YesNoDo you have proof of permission from your landlord?YesNoLandlord Contact InformationRental Consent I give my current landlord permission to release my information to WTDR regarding this adoption.How long have you been at your current residence?*Do you have a fenced yard?*YesNoHow tall?What material is the fence?*WoodChain linkOtherPlease describe the fenceDo you have other pets?*YesNoPlease describe the other pets in the home.Please record their species, breeds, ages, sizes, etc.Are your other pets altered (spayed/neutered)?YesNoWhy not?Your Veterinarian's InfoIs anyone in the house allergic to animals?*YesNoIf yes, explain.Does anyone in the house smoke?*YesNoIf yes, explain.Who will assume primary responsibility for the animal?*If you go on vacation, where will your animal go?*Do you expect any household changes in the next 6 months?*Why are you getting a new pet?* Companion Agility Jogging Walking Buddy Couch Warmer Where will your pet go when you are not home?* Crate X-Pen Fenced Yard Run of the House Other If other, describe.How long will your pet be alone during the day?*Where will your pet sleep at night?*Have you considered the cost of pet ownership?*YesNoThis can include food, housing, equipment, vet bills, etc.Do you understand that all companion animals require some form of training?*YesNoHow long will you give a new animal time to housetrain and learn the rules in a new environment?*Have you ever house trained an animal before?*I'm adopting a dog and I have experience housetraining a dogI'm adopting a dog and I do not have experience housetraining a dogI'm adopting a cat and I have experience litter training a catI'm adopting a cat and I do not have experience litter training a catUnder what conditions would you NOT keep this animal?Behaviors you would be UNWILLING or UNABLE to work through: Aggression/biting towards dogs Aggression/biting towards cats Aggression/biting towards people Aggression/biting towards children Jumping on people Scratching Pulling on leash Mouthiness / nipping Elimination in the house Destructive behavior / chewing Separation anxiety Other If other, describeAgreement #1* I understand that payment in full is required at the time the application is accepted and the home visit is scheduled (or the dog is picked up, in the case of our COVID restrictions).*Agreement #2* I understand that, if the dog is returned before the adoption is finalized, a refund of the adoption fee, minus a $50.00 non-refundable fee, will be issued by CREDIT CARD or CHECK within 30 days of the date the dog is returned.*Agreement #3* I understand that once my adoption is finalized, which is usually within 1-7 days, my paperwork can be picked up at the office or it can be mailed to me within 30 days.*Agreement #4* I understand that Wiggly Tails Dog Rescue (WTDR) reserves the right to keep part of all of the adoption fee in the event the dog is returned due to neglect or breach of contract.*Agreement #5* I understand that if I am adopting an unaltered puppy, WTDR requires an additional $50.00 REFUNDABLE deposit, paid by check, that will be held and returned as soon as WTDR receives confirmation of the altering at the appointed time.*Agreement #6* I understand that any medical costs above and beyond shots, microchip, and altering are my responsibility as the adopter.*Agreement #7* By submitting this application, I confirm that it is correct and complete. I understand that I will forfeit my adoption fee and ownership of the animal if I fail to provide accurate information.* This iframe contains the logic required to handle Ajax powered Gravity Forms.