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Application/Contract

I understand that If I do not contact my vet and allow Dirt Road Rescues to speak with them about me, or if I do not fill this application out in a complete and detailed manner, this application will not be processed*
Dog or Puppy’s name:*
Color*
Breed*
Your Name*
First Last
Home Address*
Street Address Address Line 2 City State ZIP Code
Home Phone*
Cell Phone
Email*
Are You Employed?*
Occupation*
Work Address*
Street Address Address Line 2 City State ZIP Code
Do you rent your home? If yes, please provide landlord's name and phone number*
- Yes
- No
Landlords Name*
Landlords Phone Number*
Do you have a fenced in yard?*
- Yes
- No
Are you willing to provide photos of your home?*
- Yes
- No
Please attach a photo of your home and family members living in the home*
Max. file size: 512 MB.
Maximum file size is 128MB, re-size pictures larger than this!
Picture #2
Max. file size: 512 MB.
Maximum file size is 128MB, re-size pictures larger than this!
Picture #3
Max. file size: 512 MB.
Maximum file size is 128MB, re-size pictures larger than this!
YOU MUST CALL YOUR VETERINARIAN AND GIVE PERMISSION FOR THEM TO SPEAK WITH US.
Veterinarian name, phone number and address
Reference - Include name and phone number*
Reference - Include name and phone number*
Please list any reasons you can foresee that would keep you from caring for this dog for it's entire life?*
Please list ages of everyone in household*
Why do you want to adopt a dog?*
Do you have a Facebook page and/or Instagram account and how are you listed ?*
Have you owned a dog in the past, and where is that dog now?*
How will you train your dog? Are you willing to hire professional help or attend classes if necessary?*
What will you do if your dog has a potty accident?*
Will you crate this dog/puppy? (If so please discuss this with one of our members so that we can guide you properly)*
- Yes
- No
Where will your dog sleep at night?*
How long will your dog be alone each day & where will they stay?*
If you are adopting a puppy 6 months of age or under, do you agree to have it spayed/neutered at 6 - 9 months old?*
Are you familiar with heartworms? Do you know what causes them, and are you willing to provide this dog/puppy with heartworm preventative?*
What activities will you do with your dog?*
How much time are you committed to walking and playing with your dog daily?*
Are there any circumstances that would cause you to rehome your dog?*
Where will your dog stay when you are on a trip?*
Please list age and gender of other pets in household*
If I decide that this dog does not fit well with my family within 30 days of adoption, I will contact Dirt Road Rescues and not attempt to rehome myself or take any other action to get rid of the dog. The adopter is to provide return transportation or get the pet to a different foster for Dirt Road Rescues.*
I understand that I am responsible for the care of this dog. I am responsible for any medical care that might be necessary once the dog/puppy is in my possession. I will provide annual vaccinations and heartworm preventative. I understand that intestinal parasites can reoccur in puppies and it is important to have a fecal exam done each time I take my puppy/dog to the vet.*
I agree to provide the dog with a collar and name tag with my phone number in case he/she gets lost. Pets will be transported with a collar and ID. Microchipping might be available for an additional fee. Please ask Dirt Road Rescues if interested.*
I will not keep this dog on a chain or tied up in any fashion.*
I will not allow this dog to breed with another dog.*
I will not use this dog in any sort of dog fighting or as a bait dog/used to train fighting dogs.*
Dirt Road Rescues will not be held liable for any damages that this dog might cause including harm to a person or damages to property.*
I understand that dogs are at risk for Kennel Cough when traveling together. I understand that transport guidelines and my future pet's medical records are in strict compliance and that the dog/puppy I am adopting has had at least 2 rounds of vaccinations including one Bordatella Vaccine to prevent Kennel Cough. Dirt Road Rescues is not responsible for medical bills that occur once the puppy/dog has been picked up by the owner.*
I understand that transport fees are NON-REFUNDABLE*
I agree to ONLY use POSITIVE reinforcement to train this dog/puppy and will not at ANY TIME hit, strike, spank, kick, or use ANY physical means to discipline this dog/puppy. I will contact Dirt Road Rescues immediately with any behavioral issues regarding the dog/puppy, and agree to enlist professional assistance from a qualified dog trainer/handler if required to ensure this dog/puppy learns to live a balanced life. I understand that using my voice loudly and saying “NO” or using a spray bottle of water is an appropriate way to discipline, when IMMEDIATE correction is needed to train my dog/puppy. I understand that my dog/puppy will not understand any correction other than IMMEDIATE correction DURING inappropriate behavior training.*
I agree to watch stool of my new pet carefully the first week. A bit of “stress diarrhea” is not uncommon, due to the stress of transporting. Avoid table scraps and human food. Use only pet treats to reward good behavior! Give lots of praise and a treat when your new pet uses the pee pad or the appropriate outdoor location when house training!*
I agree to contact Dirt Road Rescues within 24 hours of picking the dog/puppy up from transport, to ensure that the dog/puppy is in the new owners care and is healthy and safe. Please call or text 501-269-8566.*
Transport will be with Pack Leaders transport (plrdogtransport.com) or H.E.A.R.T.S. LLC (heartsllc.com). Dirt Road Rescues will arrange for transport and make the reservation. I agree to pay the transport fee as directed by Dirt Road Rescues. An agreed upon location will be designated for pickup.
I would prefer to pickup at Harrisburg, PA/ Port Jervis, NY/ Southington,CT/ East Hartford,CT*
Please feel free to ask for any references. Our board has been involved in Dog Rescue collectively, for many years, and we work very hard to maintain an excellent reputation. We welcome any questions and will be glad to talk to you at any time during this process. We feel adopting a dog is an extremely serious commitment.
FOR CONNECTICUT ADOPTERS: PLEASE BE SURE TO READ THE NEW STATE RULES BELOW FOR ADOPTING AN ANIMAL! You must comply with the new Connecticut Importation Law, CT Public Act No. 11-187. For review of the CT Substitute House Bill No. 5368, Public Act No. 11-187 please visit: http://www.cga.ct.gov/2011/ACT/PA/2011PA-00187-R00HB-05368-PA.htm Dogs/puppies adopted in CT must be seen by a vet within 2 days of adoption.
I agree that the above listed information is TRUE and CORRECT and understand this information will be included with my adoption contract. IF ANY INFORMATION is found to be UNTRUE AT ANY TIME (EVEN FOLLOWING ADOPTION) THE DOG WILL BE RECLAIMED AT NO EXPENSE TO DIRT ROAD RESCUES. By submitting my application I hereby give my Veterinarian, Personal References and Landlord permission to disclose to Dirt Road Rescues information that pertains to adopting from Dirt Road Rescues.
By signing this I fully understand and agree with all terms*
Date*
MM slash DD slash YYYY
After hitting the submit button on this application, you must wait for the message verifying that your application has been submitted. If you leave the page before you get a verification, your application will be lost and you will have to fill it out again. If you are having any issues with this application or attaching pictures contact support@dirtroadrescues.org .*

Application

Application/Contract

YOU MUST CALL YOUR VETERINARIAN AND GIVE PERMISSION FOR THEM TO SPEAK WITH US.

Transport will be with Pack Leaders transport (plrdogtransport.com) or H.E.A.R.T.S. LLC (heartsllc.com). Dirt Road Rescues will arrange for transport and make the reservation. I agree to pay the transport fee as directed by Dirt Road Rescues. An agreed upon location will be designated for pickup.