Jurassic Bark Rescue Adoption Contract

First Name ___________________________________________ Last Name _______________________________
Street Address _______________________________________________________________________________
City_________________ State _______Zip Code _____________ How long _______ DL #_______________
 Employed by________________________________	 How long		  
Home Phone 	         Work Phone 	
Cell Phone ________________________	E-Mail ________________________
Currently (check one): 	 Own   ____ Rent ___ Live w/parents ______ Live with friends or relatives
If you do not own your home, please provide a name and phone number of the landlord or homeowner:
Name 	         Phone 	
My adoption donation will be paid by (check one): 	 Check______ Cash_______ in the amount of :___________________    
If paying by check, my adoption address matches the address on my check and DL (check one): Yes___ No___
Do you have children under the age of 18 living at home or visiting frequently? Yes ___ No ___
If yes, please list their ages: 	   	
I am adopting a pet for (select all that apply):     	 Family Pet     	 Child's Pet     	Guard Dog
	 Gift for someone else     	 Companion for other pet     	 Watch Dog     	 Hunting Dog
My dog will primarily be kept (live) Inside_____ Outside____ Both - Inside/Outside______
Currently own    Dog(s) ___      Cat(s) ___      Other___    
 Name and phone number of your veterinarian ____________________________________________________
What type of heartworm preventative is your dog receiving? 	
Have all individuals living in the household agreed to this dog? Yes ____ No ______
I will Contact Jurassic Bark Rescue at 713-723-5599 or www.jurassicbarkrescue.org , if for ANY reason I am unable to keep my new dog. Yes_________________
Signature __________________________________________________________________Date__________
Jurassic Bark Rescue
713-723-5599