APPLICATION TO ADOPT

Canadian Association for Shar-Pei Rescue(CASPR)


Attention: D.Israel

csprescue@sympatico.ca 

 

Thank you for your interest in adopting a rescue Chinese Shar Pei.  The dogs available for adoption are screened for temperament and health.  Although the dog’s background is generally unknown we have done our best to assure a well-tempered, healthy dog.  All dog’s have been given their vaccinations, and unless very young, have been spayed or neutered.  Although, we cannot guarantee that there are no problems with the dogs in rescue, we have done our very best to assure that each dog in the program is a good candidate for a new family.  We want our dogs and our adopting families to be happy with the placement. 

The following application is very important to helping us make the right match between dog and new “parent”.  We, therefore, reserve the right, at our sole discretion, to turn down an application.  By submitting this application whether my mail, in person or via the Internet, you are giving us permission to check the references listed and demonstrating your sincere interest in pursing the adoption of a dog from our rescue program.

Instructions:  Copy and paste this application into an e-mail, fill it out and send it to csprescue@sympatico.ca


Name:

Street Address:

City:                    Province:                       Postal Code::

Home Phone:                                   Work Phone

Name of Co-Applicant:

Relationship:  (Circle choice)  Spouse   Parent    Child    Roommate     Other

E Mail address:    (Required if applying via the internet.)

Applicant’s Employer:

Position:                     Phone:

Co-Applicant’s employer:

Position:                      Phone:

1)      How did you hear about our Rescue?

     2)      What do you know about the breed  (temperament, health, etc.)?

     3)      Why do you want to adopt a Chinese Shar Pei?

Please give all the reasons that apply.  (companion, guard dog, gift, to breed, personal protection, for children, other.

4)     

Do you have a preference in coat, color, sex or age?  If yes please check.

______   Young.  (Puppy to age 2)

______   Adult.    (3-7 years old)

______   Veteran.  (7 years of older)

5)  Do you own or own your own home:  

6)  How long have you lived at the above address?

7)  What type of home do you live in?

Apartment ____

House   _____

Duplex  _____

Mobile Home  _____

Condo  ______

Other  ______

8)  If you rent, please provide us with the landlord’s name and phone number. Please
note that we will contact your landlord.

     9)   How long have you lived at this address?    _____________

    10)  Are there any covenants (restrictions, size, number, type) that prevent you from having a particular pet?

If yes please explain.  _____________________________________________

11)    Who will be responsible for the care of this dog? ______________________

12)  If you have children living in your home or that visit on a regular basis, please indicate their ages and sex.

13)  How many hours will your dog be alone per day?  ______________

14)  Who will care for this dog while you are on vacation?  ________________

15)  If you have to move what will you do with your dog?  ______________________

16)  Are you willing to take responsibility for this dog for the next 10 or more years?  _____  Even if you have your first or more children or pets?  _________

17)  Will this dog be taken annually to the veterinarian for rabies, distemper, Hepatitis, leptospirosis, parinfluenza and parvovirius inoculations and bechecked for parasites and heartworms?     Yes______    No  ______

18)  How will you control fleas and ticks?  ________________________

19)  Will this dog be kept on heartworm control year round?  Yes ____  No ______

     20)  Have you ever owned a Chinese Shar Pei?   ___________

21)    If you have owned animals in the past, what happened to those animals?

22)    If you have other animals, please fill out the sections below.

Breed/Type                Age           Spayed or Neutered

Breed/Type                Age           Spayed or Neutered

Breed/Type                Age           Spayed or Neutered

Breed/Type                Age           Spayed or Neutereed

    23)  Please provide the name and address of your veterinarian.  We will call them for a   reference.

24)    Do you have a fenced yard?

25)    What kind of fencing do you have?

26)    If you do not have a fenced yard how will your Shar Pei be exercised?

27)  Where do you plan on keeping your Shar Pei the MAJORITY of the time?

28)  Where will your dog sleep at night? 

29)  What will you do with your dog when there is no one at home?

30)  What will you do if your dog exhibits bad behavior?  Ie..being destructive, Soiling the house, barking, etc?

31)  Do you understand that this dog may not be housebroken, and are you willing to take the time to properly housetrain?

32)  Do you understand that it may take this dog time (at least 30 days) to adapt to his
or her new home?

33)  Would you be willing to adopt a dog with a medical condition (allergies, thyroid Problem. Etc).   Note.. We will not adopt out a dog with a major medical problem such as cancer.

34)  Would you be willing to adopt a dog with a behavior problem (chewing, Separation anxiety, fear of thunderstorms, not housebroken, etc.)   Note

We will not adopt a dog that is aggressive or has bitten before – under any circumstances.

35)  Are you willing to take your dog to obedience classes? If yes, please indicate the level(s) you are willing to do and any activities or sport classes you might like to participate in.

36)  Please write any additional comments below.  Use this space to also indicate Any health or behavior problems that you could NOT handle. (dog aggression, cat aggression, daily medication, etc. 

37)  Please give us names and phone numbers of three people (non family) who we can call for references.
Contact Name: __________________________ Relationship: __________________________ Phone: __________________________
Contact Name: __________________________ Relationship: __________________________ Phone: __________________________
Contact Name: __________________________ Relationship: __________________________ Phone: __________________________


1: ADOPTER is encouraged to have a licensed veterinarian of its choice examine the RESCUE DOG within 48 hours of adoption. If, within 48 hours of adoption, RESCUE DOG is found to be unhealthy, ADOPTER may return RESCUE DOG to the RESCUE for a refund of any portion of the adoption fee paid. Otherwise, ADOPTER accepts full responsibility for the health and temperament of RESCUE DOG. No refunds or reimbursements will be made by the RESCUE for any costs incurred by ADOPTER, e.g., food, leash, collar, veterinarian bills, etc.

2: ADOPTER agrees that it will not find RESCUE DOG a new home without approval of RESCUE. If for any reason the ADOPTER can no longer keep the animal, the RESCUE is willing to take back the dog. All potential adoptions must take place through RESCUE. Except as provided in paragraphs 1, above, no portion of the adoption fee will be refunded, nor will any costs incurred by ADOPTER, e.g., food, leash, collar, veterinarian bills, etc., be reimbursed by RESCUE.

3: ADOPTER understands that the temperament, pedigree, and health of RESCUE DOG are not, or may not be fully known, and does hereby assume full responsibility for any and all actions of, and for any and all personal injuries and/or damages that may be caused by, RESCUE DOG. The ADOPTER agrees to indemnify and hold harmless RESCUE from any and all claims, damages, losses, fees or costs arising from or relating to any claims for personal or other injuries or damages caused by RESCUE DOG. ADOPTER also acknowledges that RESCUE cannot guarantee the health and longevity of RESCUE DOG and will be held harmless for any medical costs that arise from RESCUE DOG. In the case where a temperament/character issue is known, the ADOPTER hereby declares their willingness to proceed with the adoption irregardless and hereby declares their assumption of ALL and ANY liabilities of the RESCUE DOG.

4: ADOPTER agrees and understands that the rescue will attempt to make a home visit where the dog will reside. This will be done before the adoption and at the Rescue's discretion (with notice), after the adoption.


NAME OF THE DOG YOU WANT TO ADOPT: _________________________________________________
BREED: _________________________________________________
COLOUR: _________________________________________________
COAT TYPE: _________________________________________________
SEX: _________________________________________________
AGE: _________________________________________________
ADOPTION FEE: _________________________________________________

BY SIGNING THIS FORM YOU CONFIRM AND AGREE THAT:

If you move or change your residence, or general contact information, please take appropriate measures to update this information with us immediately. By adopting this animal from us you agree that we may always be in a capacity to contact you and know the physical location of the adopted rescue dog at all times. It is your obligation to permit us to inquire about the general welfare of our dogs.

You agree that a puppy/dog that is not sterilized is subject mandatory sterilization at the appropriate age, at your expense and will NOT be used for breeding purposes under any circumstances.

You understand that your Shar Pei is never to be left outdoors for extended periods or chained.

You understand that the dogs are animals whose characters/health may change with time, environment and conditioning, and that the Rescue cannot know all of the pre-existing issues nor predict future issues that may or may not reside within the character or health of any dog.

The Adopter, Foster Home agent or Volunteer being of lawful age, on signing this form, release, acquit and forever discharge The Canadian Association for Shar Pei Rescue, its Agents, Volunteers and Assigns, from any and all actions, claims, demands or damages to me, from known or unknown temperament/character issues, any known or unknown injury, loss or damage, sustained by myself or this dog, as a result of acting as a CASPR Foster Agent or Volunteer, or Adopter in whole or in part.

I ACKNOWLEDGE THAT ALL THE INFORMATION CONTAINED ON THIS FORM IS TRUE AND CORRECT. I UNDERSTAND THAT ANY MISREPRESENTATIONS OF FACT MAY RESULT IN THE REMOVAL OF THE DOG FROM MY HOME OR ADDITIONAL ACTION DEAMED NECESSARY FOR THE WELL BEING OF THE ADOPTED DOG.


SIGNATURE:              _________________________________________________ DATE: _______________


WITNESS SIGNATURE: _________________________________________________ DATE: _______________

BY COMPLETING THIS APPLICATION FOR ADOPTION YOU ARE INDICATING THAT YOU HAVE READ, UNDERSTOOD, ACCEPT AND AGREE TO THE ABOVE MENTIONED CONDITIONS and TERMS OF ADOPTION, as governed by this agreement and the Laws of Ontario, Canada.