We realize this application asks for a lot of information. But remember, we are giving up a pet that we have become close to and we want the best for the pet. We hope you understand. Please return to:                                akita77@gmail.com CENTEX AKITA RESCUE (CAR) ADOPTION APPLICATION Name______________________________________ Home Phone _______________ Street Address_______________________________________________________ State ______________________Zip Code ___________________    E-mail address(s)________________________________________________________ Why do you want an Akita / German Shepherd / Mix? (circle one) _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ If you currently have other animals, what kind? __________________________________ What sex? ______________________Spayed/neutered_____ If not spayed/neutered, why not? _____________________________________________________________ _____________________________________________________________ Have you owned a large dog before? (If yes, explain) _____________________________________________________________________ _____________________________________________________________________ What happened to your previous pets? (if passed away, explain) _____________________________________________________________________ How many people in your household? _______ What relationship to you? _____________ If any children residing, or visiting on a regular basis, what are their ages and sex? _______________________________________________ Who is home during the day? ______________________________________________ Do you do day care in your home? ______ Do you own your home? _________ If renting, does the lease permit large dogs? ____  (if so, copy required with this application) How long have you lived here? _________________   If less than two years, give previous address and how long you lived there: _____________________________________________________________________ _____________________________________________________________________ What is your lot size? _____ is it fenced?_______ material ________height _____ If no fence, are you willing to provide a fenced area or kennel run?   ____ Where will the dog be during the day? __________________ at night? ________ When you are away overnight? _____________________________________________ If there are no children or other animals in your house, are there foreseeable times the pet will have to spend visiting with children or other animals ?______ if yes explain ___________________________________________________________ ___________________________________________________________ Are there any unusual circumstances to which the pet will have to adjust? _____________ If so, explain___________________________________________________________ _____________________________________________________________________ Who will be the primary caretaker?________________________________________ Do all family members want the pet? ____ _____________________________________________________________________ Can you spend a minimum of one hour daily total quality time (aside from feeding, grooming,  and letting the pet in and out) ________ If anyone else will be caring for the Akita, identify, and give name, address, ______________________________________________________________ Are you informed of local zoning and dog ownership ordinances? ___ Will you be in compliance? ____ REFERENCES: VET(S)  Provide the name, address and phone number of any veterinarians that you use: _____________________________________________________________________ _____________________________________________________________________ PERSONAL: Two individuals, not relatives, who know or have known your other animals past and present.  Names,  & phone numbers. ____________________________________________________________________ ____________________________________________________________________ May we visit your home and check your references to verify the information you have provided? _____ ******************************* Akita's only: Remembering that Akita's rarely co-exist peacefully with same sex of any breed, and the majority of rescue dogs are adults or young adults, what sex and general age category do you have in mind to adopt?  Sex _____ Age ______. Although we cannot choose dogs by coat color or coat length, do you have a preference? Color? _____________ would consider a long coat? ________________ ****************************** Contract Requirements: A. The dog is not to reside anywhere without a fenced yard unless the adopter can provide adequate exercise. B. The dog will not be chained to a doghouse or chained outside to any type of object or outbuilding. C. The dog is not to live in a garage, doghouse, or any type of outbuilding. D. Shelter from weather must be provided for the dog at any time that the dog is outside if the weather is extreme heat, extreme cold, or any other weather conditions that may endanger the health of the dog. E. The dog is not to remain solely in a crate while indoors, only while the adopter is not at home, if at all, and not for more than eight (8) hours a day. The dog shall reside indoors, in the adopter's home, and live as a family member and companion only. The dog will not be kept outdoors during the adopter's working hours, or at any other time left alone outdoors while the adopter is not at home. The dog may be confined to a room such as a bedroom or basement or any other room of adequate size and protected from the elements of weather. The adopter is not to expose the dog to harmful objects, poisons, or other living creatures that may endanger the dog's life. The dog may be crated for no longer than eight (8) hours in a twenty-four (24) hour period of time. The crate must be large enough for the dog to stand up in, and turn around in as well as having the proper floor of the crate for the dog to lie comfortably on its side. F. While the adopter is at home, the dog is not to remain solely in one room, not to be confined to either the crate or a room, and must have free roam of the house as a family member. G.  The dog is not to be left with small children at anytime when unattended by an adult. H. The adopter must provide rescuer with the name of the veterinarian the dog is going to and notify rescuer if there is a change. I. The dog must remain on heartworm preventative all year round. The adult dog when adopted will be seen by a veterinarian within five (5) days of the adoption date to start or continue the heartworm preventative program and to get a fecal est done to be sure the dog is free of parasites.  Renewal of rabies vaccine is required by law and therefore by the terms of this contract J. The dog shall not be trained, encouraged, nor misrepresented for the purpose of protection, aggression, or any aggravated display of behavior. The adopter promises that under no circumstances will the dog be trained to develop a dual personality, as defined: no protection, attack, schutzhund, or guard dog training is permitted. The dog will not be encouraged to show any aggressive or agitated behavior. The dog will be a family member only and only participate in good citizen, basic obedience, search and rescue, therapy dog training, or service dog training.  The dog will not be maintained as property or for the purpose of being a deterrent due to size, appearance, or display and encouragement of territorial behavior. K. The dog is to have adequate food, water and shelter at all times. L. The adopter shall refrain from physical abuse of the animal and from otherwise treating the animal in an inhumane manner. M. The dog will not ride in the back of a pickup truck under any circumstances including those such as in a cage/kennel, or tied. The dog shall not remain in any vehicle in extreme heat, with windows up or down, or unattended for any amount of time. N. Spay Agreement:  This spay agreement is an agreement that the female dog will not produce a litter of puppies either as purposely bred or by accidental breeding. The rescuer's female dog adopted as a puppy will be spayed prior to adoption or must be spayed within 30 days or 6 months of age, whichever is appropriate. O. Neuter Agreement: The rescued male dog shall be neutered prior to the adoption or must be neutered within 30 days or 6 months of age, whichever is appropriate.. P. The dog shall at all times be required to wear a nylon belt buckle collar with the rabies tag, identification tag (displaying the home address and the county license). Q. The dog shall not be sold, given to, or adopted to anyone else, nor shall there be any transfer of ownership to any firm, corporation, or organization of other homeless animals, such as another rescue facility, or research facility. The dog adopted from rescuer must be returned to rescuer if for any reason the adopter can no longer keep it. Do you, the undersigned, understand that any misrepresentation of ourself or any untruths herein this application that are discovered at a later date will invalidate any adoption agreement and will give CAR the right to reclaim the pet with no refund of the adoption fee? ___________ Do you agree that the pet will never be sold, given away, abandoned, or otherwise separated from your family, and that if it ever becomes necessary to re-home the pet, you will contact Centex Akita rescue before any action is taken? ___________ If the pet you decide to take has not been neutered/spayed, you will be required leave a deposit of $100.00 to be refunded upon notification and confirmation of the neuter/spay being completed. Signature____________________________________Date____________________ Signature____________________________________Date____________________