Your Name *

First Name

Last Name

Your Phone *

(###)

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Partner Name ***Partner contact information is required if married or co-adopting

First Name

Last Name

Partner Phone

(###)

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Your Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Personal Reference *

Friend or relative not living with you

First Name

Last Name

Reference's Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Reference's Phone *

(###)

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Landlord's Name

First Name

Last Name

Landlord's Phone

(###)

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I agree to schedule an appointment with my veterinarian within 72 hours after finalization of adopted animal *

I agree

I agree to allow Riley's Rescue of Brevard representatives access to any and all medical files and medical information related to the adopted animal. This applies for the life of the animal. This allows Riley's Rescue of Brevard Representatives to ensure that the contract [to continue vetting] is being upheld. *

I agree

Name of your Veterinarian *

First Name

Last Name

Your Veterinarian's Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Your Veterinarian's Phone *

(###)

###

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As the adopter, I agree to the following conditions for adoption: I agree to NEVER chain or tether the animal outdoors unsupervised for any length of time. *

I Agree

The dog is NEVER to be left outdoors unattended for any length of time, regardless of whether the dog is in the fenced area or not. Supervision saves lives! *

I agree

I understand that Heartworm Prevention is a must year round in Florida. It only takes one mosquito to infect your animal with heartworm. *

I understand

I do not understand and would like to discuss

I agree to provide my animal with necessary MONTHLY heartworm prevention. This is *typically a pill given once a month with food. *

I agree

I do not understand and would like to discuss

I agree to keep identification tags attached to a properly fitted collar. This will remain on the animal at all times, whether inside or outside of the house (unless crated). *

I agree

I agree to have the adopted animal on leash and under my control when it is not on the confines of my property. *

I agree

I agree to supply the adopted animal with the necessary vaccinations as required by the county, at the intervals advised by my veterinarian and supply all other medical care as needed. *

I agree

If for some reason I can no longer care for this animal, I will notify Riley's Rescue of Brevard immediately. *

I Agree

I agree to NEVER re home, give away, trade, transfer or sell this animal without the WRITTEN consent of Riley’s Rescue of Brevard representatives. *

I Agree

I agree not to strike, abuse or neglect the adopted animal and I authorize Riley’s Rescue of Brevard representatives at their sole discretion, to determine whether or not the animal has been struck, abused or neglected. *

I Agree

I agree, should this animal ever end up at an animal shelter or rescue group, Riley’s Rescue of Brevard representatives have legal authority to immediately regain custody, control and ownership of adopted animal. *

I Agree

I agree to notify Riley’s Rescue of Brevard representatives within 12 hours if adopted animal gets loose, becomes at large or is otherwise unaccounted for, and I agree to make EVERY reasonable effort to find and reclaim the animal. *

I Agree

I understand that any failure to perform the foregoing agreement will constitute a breach of contract. In the event of any such breach of contract, I authorize Riley’s Rescue of Brevard representatives to reclaim both possession and ownership of the adopted animal with no reimbursement of any costs incurred. *

I Agree

I agree to notify Riley’s Rescue of Brevard representatives Immediately of any change of address or phone number.

I Agree

I agree to use Sentinel or an equivalent substitute on our animal. *

I Agree

I agree to take our dog to all needed training to set them up for success. Puppies required to be taken to a Basic Puppy training course. (n/a if not a puppy being adopted) *

I Agree