Beagle
Rescue & Hospice
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Adoptable Beagles
Adoption Process
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Signature Capture
Accuracy:
meters
Address:
Date/Time:
Thank you for allowing us to provide your care at home! By signing this document, you are agreeing that the clinician was present at the date and time stated and performed skilled treatment. Your signature will be used to verify the visit as well as the location of service. If there are any discrepancies, please notify our office!
When you are ready to sign, please tap the "Capture Signature" button below.
Adoption Application
Applicant Information
October 2, 2023
Name:
Phone Number:
Address:
City:
State:
AL
AK
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WI
WV
WY
Zip:
Date of Birth:
Driver's License Number:
State Issued:
AL
AK
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WI
WV
WY
Property Type:
House
Condominium/Townhouse
Apartment
Own
Rent
E-mail Address:
Landlord Name:
Landlord Telephone:
Veterinarian:
Clinic Name:
Phone Number:
Previous/Current Pets
Type
Breed
Age
Sex
Altered
How Long?
Still Present
Male
Female
No
Yes
No
Yes
Male
Female
No
Yes
No
Yes
Male
Female
No
Yes
No
Yes
Male
Female
No
Yes
No
Yes
Male
Female
No
Yes
No
Yes
If any pets are no longer present, please explain:
Household Information
Name
Age
Relationship to Applicant
Gender
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Yard:
Fenced
Partially Fenced
Invisible Fence
No Fence
When Not Home:
Crated
Gated
Free Roaming
House Training:
In Yard
On Leash
On Tether
On Pads
References
Name
Relationship
Phone Number
If you have any additional comments regarding your application, or are interested in any specific beagles, please indicate below:
Please read and sign: There are many factors that go into the pet adoption process. I understand that each beagle has individual needs and will go to the home that is best fit for them. I understand that the approval for adoption is contingent upon the best interest of each beagle as an individual and that I have the right for clarification if my application is rejected. I agree that if adopted, and there are any problems, the beagle will be returned to the rescue at any time and that I will be asked for the reasons that the beagle was not a good fit so as to facilitate appropriate future adoption.
By signing below, I indicate that I have read the agreement and information provided and certify that all statements made by me in this adoption application are true.
**If completing this form on a touch screen device, you can sign on the line below. Alternatively, you can choose "Create Link" and then sign on a touch screen device.
Applicant's Printed Name
Applicant's Signature
Date
Witness's Printed Name
Witness's Signature
Date
