Animal Adoption Request Application 2003

Death Row Listed Pets- Your Application info will be sent to Group holding pet.

Information is used ONLY to evaluate Pet Adoption & is not sold or marketed.

See our privacy notice on the main page.  What pet do you want to adopt ?

Your First Name Your Last Name Phone

Street Address  Town/Village/City

Zip Code   Alternate Phone # Is this where pet will be

Your E-mail address

Do You live in a house/apartment City/Village/Town/Rural

Do You have a yard Y/N How Big ? Is the Yard Fenced/Type

Do you have small children 1-5 years Old ? Yes No        Are you planning any ?

 Comment- Pets are not child substitutes. Pets usually suffer from neglect/jealousy after babies are introduced into the family. It is better to wait. Nor are they good babysitters in lieu of parental involvement/supervision. Pets are better with older more responsible children who can interact.

Have you ever had a pet before ?  Yes No    What Type Dog Cat Other

What happened to them ?

How many other pets/types do you have now ?

Who takes care of them ? Who gives them water ?   Who feeds them ?

                                        Who walks them ?            Who plays with them ?

                                        Who Trains them ?           Who disciplines them ?

                                        How much time do you spend with your pets interacting per week?

 Comment- This is a subtle reminder that having a pet brings lots of duties/responsibilities and commitment of time for the next 12-15 years.

 Why do you want a pet ?

 Do You have other Friends/Family in the immediate area who share your interest in pets ?

 Are you planning on attending college out of the area in the next few years ? Yes No

  The Following are stress factors for the pet. Some pets need low stress environments. Are the following present in your home ?

      Frequent Loud Rock Music Yes        Frequent Domestic Disagreements     Yes 

       Loud Shouting/Arguing       Yes       Frequent Loud Violent Video Games   Yes

       Loud Engine Noise cars/planes  Yes   Loud Neighborhood Noise Music/Gangs  Yes

       Lots of other Area Barking Dogs Yes   Heavy Traffic Noise/Highways/railroad Yes

       Regular Neighbor Commotion Fights/Arguments/Yelling Yes  Animal Fighting Ongoing Yes

 Comment-While you may genuinely want a pet and may be an excellent pet parent these types of environments can cause pet stress, biting and other behavior problems for pets. These type environments are NOT suggested or recommended in most cases. They can be alleviated by car rides, park walks, neighborhood walks and of course.... moving.. ;)

       Do you have a current or former veterinarian ?  Yes No 

    Who is/was your veterinarian ?   Phone

  These are lifestyle questions:

  Do you work full time ? Yes No     Retired/Disability Yes No

  Is there someone else who will walk/take out pet for you ? Who ?

  Do you travel frequently ? Yes No Who will watch pet ?

  Has there ever been an incident of physical domestic abuse in the home ? Yes No

  Does anyone in the household drink/do drugs frequently ? Yes No

  Is the household contemplating divorce/seperation ? Yes No 

  Do you have a similar pet owning friend ? Who ?

  Would they help with your pet care or you with theirs ?

  Comment-While these might seem unduly intrusive. Many Times these indicators can serve to show the presence of stress and potential for problems that may adversely effect the pets as well as the humans in the household. If these Items/factors are present they do not BAR you from having a pet. Many times pets can be very helpful in these circumstances. it just has to be evaluated and properly considered for its impact on you and on them

. The Following questions MUST be answered and initialled. It is agreed that placement of a pet with you is conditioned upon negative "NO" answers to the following 4 questions. It is agreed by your application and acceptance of placement that a contractual agreement comes into existence upon our acceptance of your application and our giving you a pet as consideration. Should any question subsequently turn out to be true during the expected life time of the pet placed with you you agree to pay the sum of $ 25,000 as liquidated damages to Animal Sanctuary of Vails Gate, NY or alternatively to the ASPCA of the State of New York as liquidated damages.  

 1) Have you ever or would you ever consider the sale or donation of a dog or cat or other pet in your custody to any laboratory facility either directly or indirectly for testing, dissection or drug sampling ?  Yes No  Your Initials 

 2) Have you ever been arrested for assault, child abuse, or animal cruelty at any time ?

                                            Yes No Your Initials

 3) Have you ever witnessed, engaged in, attended or had an interest in Dog Fighting as a competitive "sport" ?             Yes No Your Initials

 4) Would you ever use a pet that you have custody of as a combatant, as a training aid, as bait, or in any other way in conjunction with the "sport" of dogfighting.

                                             Yes No Your Initials

 5) Do you understand that this application if accepted could result in placement of a pet with you and as such it represents a valid legal contract between YOU and the animal placement agency who we are acting as agent for, and do you understand that as part of that contract if you falsely indicate a "NO" answer for any of these 4 questions when your answer should have been "YES" or subsequent facts and conduct establish that your answer should have been "YES" you agree to a default judgment for liquidated damages in the amount of  $ 25,000 to be paid to either Animal Sanctuary of Vails Gate or the ASPCA of New York State ?

    Yes, I understand & I agree to this Liquidated Damage Liability for these 4 items..

    Signed by Typing Your Full name last & first with a comma 

    Almost Done....and sadly yes this last part IS very necessary. Thank You for your patience and your time. Please click on the submit button below and we will evaluate your application and get in contact with you about placement or transition visits.

    If for some reason as a result of this application you realize this may not be the right time or circumstance to bring a pet into your lives consider two other programs 1) pet foster parent temporary placement where you can help a Death Row pet stay alive by sheltering a pet for a few weeks/months 2) Shared Custody Network, perfect for single professionals who agree to share responsibility & ownership.

   <<<< Click Here to submit