Dog/Puppy Adoption General Information and Preadoption Form

This form is for adopting a dog or puppy as a pet

Here are ----> Dogs/Puppies for Adoption as Pets

Introduction


Please complete the following questionnaire if you are interested in adopting a Circle Tail dog/pup. Answer all questions to help us ensure that you and your companion are a good match. Our goal is to ensure a happy and successful transition of your pet into their new home. Please read the "adoption information and agreement" that follows the questions and submit the form to Circle Tail.

Note that most of our dogs are not housed at Circle Tail -- they are in one of the Ohio correctional institutions with whom we work learning house training and basic obedience. Once you and your adoption counselor have decided on an appropriate dog for you/your family, an appointment to meet the dog will be scheduled.

Here is our ----> Privacy Statement

All Fields are Required. Use NA, if not applicable.

Date: (mm/dd/yyyy)

Questionnaire Submittal Time:

Name of dog/puppy to adopt (if known):

Would you like us to provide suggestions for appropriate dogs to adopt?

Yes No Not Sure

Applicant Name:

Street Address:

City & State:   Zip Code:

Primary Phone: Cell Phone:

Email that you regularly check:

Why do you want a dog?

Gender Preference: Male Female No Preference

Size Preference:

-Extra Small (under 10 - 15 lbs)
-Small (15 - 30 lbs)
-Medium (30 - 60 lbs)
-Large (60 - 90 lbs)
-Giant (90 lbs or more)
-No Preference

Please Describe Size Preference:

Preferred Age Range:

Breed Preference:

Indicate any breeds you do not prefer:

What breed(s)/ type(s) of dogs have you had responsibility for as the primary caregiver, and how long did you have each of them?

Do you have a cat at home: Yes No?

Name/Breed/Age/Gender of Dogs at Home:

Veterinarian's Contact Information: (If no vet, enter NA for required name & phone)

Name:

Office Phone:

Number of people in household, including yourself:

Ages of children in household:

Who will be the dog's primary caregiver:

Do you live in a Town/City, Suburb or Rural Area?

Do you live in a House, or an Apartment?

If you rent, please provide the following information.
Please insert NA in each box, if you do not rent.

Landlord Name
Landlord Phone with Area Code

Do you have a fenced yard: Yes No
If yes, is fence solid or electric (If no fence, insert NA.)

I have visitors over:

-All the time -- I installed a revolving door
-A lot
-Sometimes - I have occasional friends and family over
-Rarely - I don't even know if my doorbell works

Please Describe Visitor Frequency:

Do you want a dog who likes to exercise:

-Hardly at all - "couch potato"
-Moderately - 30 - 40 minute walk per day, playing fetch, etc.
-A lot, a running/hiking partner

Please Describe Exercise Preference:

Number of hours per day the dog will be routinely left alone:

Is it ok to conduct a scheduled home visit before the adoption takes place? Yes No

By indicating my interest to adopt this animal and submitting this form, I understand and agree to the following:

  1. To keep this pet in accordance with local regulations. I will have my dog/pup licensed within 30 days and then yearly.
  2. To provide this animal with proper shelter, adequate food and water, and medical care to maintain his/her health and well being.
  3. This animal will reside indoors (unless otherwise indicated on this form by a Circle Tail representative).
  4. To establish a schedule of preventative medicine with a veterinarian.
  5. To obtain immediate veterinarian care if the animal becomes sick or injured.
  6. This animal will not be used for any experimental purposes.
  7. I have been advised to take my new pet to the veterinarian within 7 days of adoption at my expense. I understand that all additional vet care following adoption is my financial responsibility.
  8. If the pet proves to be in such poor health that major treatment is necessary within 7 days, I may return the pet for a refund of the adoption fee or proceed with the treatment at my own expense.
  9. Within 2 weeks of the original adoption date, this animal may be returned to Circle Tail due to any health or temperament reason. Upon return of all paperwork, including medical information form, my adoption fee will be refunded.
  10. If I can no longer care for this pet, I can contact Circle Tail to discuss/ assist with re-homing him/her.
  11. I will be personally responsible for the humane care of my adopted pet and will indemnify and hold Circle Tail, Inc. harmless if this animal causes injury to a human or other animal, or damage to property after the adoption.
  12. With advanced notice, a representative from Circle Tail may visit the pet at any time. If not satisfied with the animal’s living conditions/appearance, the pet may be reclaimed by Circle Tail.
  13. Circle Tail, Inc. reserves the right to resume ownership of the animal if the above conditions are not met.

Please acknowledge that you have read, understand, and agree to the adoption conditions by typing "YES" (all capital letters) in the following box:

Please provide any additional comment you wish:

Input text from image bellow:


Please click the Submit button only once. It takes a few seconds for the form to be processed.

The following three things will happen next:

1. You Will See a Thank You Page.

If you have completed all required fields, once you click Submit, you will see a Thank You page. If you have not completed all required fields, you will be asked to complete the required fields before the form can be submitted and you see the Thank You page.

2. You Should Receive an Auto-Response Email.

If you have completed all required fields, once you click Submit, you and Circle Tail will be sent an auto-response email containing the information you supplied for the form. If you do not receive the email, please click the back button on your browser and make sure your email address is correct and click the Submit button again. Also check your spam or junk mail folder.

3. Within Two Days You Will Get an Email from a Circle Tail Volunteer.

Please be sure to check your spam or junk mail folder as well as your inbox. If you do not get an email from a Circle Tail volunteer, please email adoption@circletail.org.

Still Having Difficulties?

If you are still having difficulties submitting the form, you are welcome to print and fax it to 513-277-6064 (make sure all the selections are clearly completed). You also can right-click, save and complete this MS Word Preadoption Form and email it to adoption@circletail.org as an attachment. We would appreciate knowing the details of the difficulties you had, so we can correct problems. Please email us at adoption@circletail.org.

Circle Tail, Inc.
8834 Carey Lane
Pleasant Plain, OH 45162