Adoption Application

Thank you for taking the time to fill out this application. Your information will remain confidential and used only as part of the Second Chance Chi Rescue Foster Program.

All fields marked (REQUIRED) must be filled in or your application will not go through. To save time on the phone when we call you, make sure you fill this application out in its entirety so we wont have as many questions when we talk.

Applicant Information

(REQUIRED)
(REQUIRED)
(REQUIRED)
 - 
(REQUIRED)
(REQUIRED)
(REQUIRED)
 - 

Spouse / Sig Other Children / Roommates

Residence Information (A letter from your landlord or apartment manager will be required if you rent.)

(REQUIRED)
(REQUIRED)
(REQUIRED)
 - 
(REQUIRED)

Personal References (All personal references will be checked)

(REQUIRED)
(REQUIRED)
 - 
(REQUIRED)
(REQUIRED)
 - 
(REQUIRED)
(REQUIRED)
 - 

Veterinary References (All Vet references will be verified)

(REQUIRED)
(REQUIRED)
(REQUIRED)
(REQUIRED)
 - 

Present and Past Pet History

Training & Disclipine

General Questions

About The Dog You Want To Adopt

Agreement And Signature (All fields Required)

(REQUIRED)
(REQUIRED)
(REQUIRED)
(REQUIRED)
(REQUIRED)
(REQUIRED)
(REQUIRED)
(REQUIRED)
(REQUIRED)

I accept this dog as my companion pet if Second Chance Chi Rescue accepts my offer to adopt the dog. I have agreed to offer a tax-deductible, non-refundable donation or adoption payment of $250.00 or $350.00 (For dogs under 1 year old) to assist with the payment of prior veterinary care for the dog, as well as helping Second Chance Chi to rescue more dogs in the future.

  1. In consideration for adopting the dog, I agree to the following adoption conditions.
  • To accept and consider this dog as a household companion and to provide this dog with humane care and treatment, including proper food, water, shelter and exercise, and to give this dog a reasonable amount of time to adjust to its new home.
  • To register the dog with, and obtain a dog license from the municipality where I live, or as required by law.
  • To safeguard the dog from loss or mishap. This means not allowing the dog to run at large unsupervised, and keeping the dog at all times at the premises listed as our address.
  • If the dog is lost or stolen, to immediately notify Second Chance Chi Rescue at the emergency contact information given within the adoption papers, and to make every reasonable effort to recover the dog by contacting all local shelters, pounds and centers for Animal Care and Control centers.
  • NOT to give or sell the dog to another person, relative, or any other individual, or any other rescue group, humane association, shelter or pound, or any medical or experimental laboratory, or any organization.
  • NOT to alter the dog’s appearance in any way, shape or form (e.g. cropping, docking).
  • To immediately notify Second Chance Chi Rescue in the event of death and prior to disposal of the dog’s body.
  • To allow a Second Chance Chi Rescue representative to make periodic visits to my home during the first 90 days following the signing of this agreement.
  • To immediately notify Second Chance Chi Rescue of any change in address or telephone number and of any change in circumstances that may prevent me from keeping the dog, or to comply with any of the terms and conditions contained herein.
  • After 30 days, To immediately contact Second Chance Chi Rescue to arrange for them to help re-home the dog in the event that I, or my immediate family members charged with care of the dog, cannot keep the dog and provide the care set forth in Paragraph 1(a) for any reason. Under no conditions, shall I surrender the dog to a shelter or euthanize the dog, except if a licensed veterinarian determines that the dog is terminally ill, or is suffering from a medical condition for which the licensed veterinarian advises euthanasia.

2. I understand that the dog has been checked, spayed/neutered and vaccinated by a licensed veterinarian and that his/her state of health is accurately represented to the best knowledge of Second Chance Chi Rescue. Any and all medical attention that has been deemed necessary has been done. I understand that any further medical attention desired must be at my own expense. Second Chance Chi Rescue suggests that I have the dog examined by my own veterinarian within seven (7) days of adoption, and if it is determined that the health of the animal is not satisfactory, I may return the dog.

3. I am aware that the educated opinions of the Second Chance Chi Rescue staff do not constitute a claim or guarantee as to the absolute age, temperament, health, or mental disposition of any animal available for foster or adoption. With that in mind, I hereby accept possession, legal guardianship, and responsibility for the animal I am adopting, and discharge Second Chance Chi Rescue forever from liability for any injury or damage to any person or property caused in the future by said animal, and from any causes of action, claims, suits, or demands whatsoever that may arise as a result of such injury or damages. Second Chance Chi Rescue is in no way responsible for any future training or medical issues that may occur post adoption.

4. I have read and fully understand the terms and conditions of this agreement, and agree that it is not arbitrary and is common in pet adoption contracts. I further understand that if I fail to comply with any of the terms specified herein Second Chance Chi Rescue has the right to reclaim the dog and to enforce this contract in a court of law. In the event that Second Chance Chi Rescue be required to take legal action in order to secure the adopted animal(s), adopter(s) shall pay all costs associated with said legal proceedings. This Contract shall be governed by the laws of the (State of UTAH) without regard to principles of conflict of laws.

THE ABOVE IS A LEGAL AND BINDING CONTRACT. BY SIGNING BELOW, THE ADOPTER(S) AGREES TO COMPLY WITH EVERY CONDITION LISTED ABOVE. THE ADOPTER(S) FURTHER AGREES TO IMMEDIATELY SURRENDER AND RETURN THE ADOPTED PET(S) TO SECOND CHANCE CHI RESCUE SHOULD SECOND CHANCE CHI RESCUE DETERMINE THAT THE ADOPTER(S) HAS FAILED TO COMPLY WITH ANY OF THE CONDITIONS LISTED ABOVE. IN THE EVENT SECOND CHANCE CHI RESCUE BE REQUIRED TO TAKE LEGAL ACTION IN ORDER TO SECURE THE ADOPTED ANIMAL(S), ADOPTER(S) SHALL PAY ALL COSTS ASSOCIATED WITH SAID LEGAL PROCEEDINGS.

I HAVE READ AND UNDERSTAND THIS CONTRACT AND BY SIGNING THIS DOCUMENT I WAIVE ALL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE SECOND CHANCE CHI RESCUE AND ITS OFFICERS, DIRECTORS, AGENTS, EMPLOYEES, VOLUNTEERS AND/OR REPRESENTATIVES.

IN THE EVENT OF MY DEATH OR INCAPACITY, THIS CONTRACT SHALL BE EFFECTIVE AND BINDING UPON MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS AND REPRESENTATIVES.

(REQUIRED)
(REQUIRED)
(REQUIRED)
(REQUIRED)
(REQUIRED)
(REQUIRED)