Central Valley Collie & Sheltie Rescue

(360) 477-6670

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C.V.C.S.R. Adoption Application

Before completing the Adoption Application, please read, sign, and date this section, stating that you fully understand our rules. This is what you are agreeing to when you sign the actual adoption agreement.

I, the undersigned, agree to adopt the dog described below and to release Central Valley Collie & Sheltie Rescue of any and all liability. This release of liability includes, but is not limited to, any damage the dog may cause after its adoption and acceptance into my home. I have picked this dog of my own free will. C.V.C.S.R. attempts to ensure that all dogs are healthy at the time of adoption; however, no guarantees are made. Further, because of the high cost of canine dental care, only a quick check was done by the vet. C.V.C.S.R. will not be responsible for any dental problems the dog may have. C.V.C.S.R. provides a full 30 (thirty) day return and exchange policy on every dog we place. No refunds will be given if the dog is returned in healthy condition to C.V.C.S.R. within 30 days from date of adoption, but an exchange will be provided at no additional cost (except a possible spay/neuter fee if not paid on the first dog). I will see to it that the dog always has plenty of clean, fresh water, that it is fed daily with a quality dog food, and that it will always be well groomed. This dog has been A.V.I.D. microchipped in the name of C.V.C.S.R., and it cannot be transferred into the adopter's name.

I will abide by the following dictates: (1) If at any time in the future this adoption must be terminated, the dog must be returned to C.V.C.S.R. and not disposed of in any other way, (2) a C.V.C.S.R. representative will be allowed occasional visitation rights, (3) if I move, I will notify C.V.C.S.R. of my new address and telephone number within 10 (ten) days, and (4) I agree, within 30 (thirty) days, to purchase a collar and to keep the collar with a current county or city dog license and ID tag on the dog 24 hours a day. If a C.V.C.S.R. representative ever sees the dog without its license and ID tag, the dog can be removed from the adoptive home with no refund due and no legal action required.


I have read and agree to the above terms: ___________________________________ Date: ________________

Please print all requested information clearly


Name: ________________________________________________________________ Date: ______________

Address: ________________________________________________________________

City: _____________________________________ State:_________________ Zip:________

Telephone No.: Day (____)________________ Evening (____)________________

E-mail Address: _________________________________

Employed by: ______________________________________________________________________________

Drivers License No.: _________________________ Expires: __________________

Nearest relative not living with you: _______________________________________

Telephone No.: (____)____________________ Relationship: _________________

Is this location a: House (  ) Mobile Home (  ) Apartment (  ) Townhouse/Condo (  )

Do you own or rent this property? Own (  ) Rent (  )

Do any children under 7 years of age either live at or spend time at this address? ______

If so, what are their ages? ______, ______, ______, ______, ______

Do you currently have any other? Dogs: _______ Cats: _______

Breed(s) of dog(s): __________________________________

If above answer is yes, are they all spayed or neutered? Yes (  ) No (  )

If you had other pets in the past 5 years and no longer have them, what happened to them?



If you did, or still do, have any other pets, who is/was your vet?

Name: ___________________________________________________________________________________

City: __________________________________ Telephone No.: (____)________________

At night, where will the dog sleep? Inside (  ) Outside (  ) Garage (  )

Is your backyard fully fenced? Yes (  ) No (  )

If not fully fenced, do you have a fully enclosed dog run? Yes (  ) No (  )

Will the dog ever be allowed to run loose outside the enclosed yard? Yes (  ) No (  )

Are you interested in basic obedience training? Yes (  ) No (  )


Important Information. Please read before signing below.

Do you understand that the Central Valley Collie & Sheltie Rescue charges an adoption donation on all dogs to help partially cover the costs of veterinary care, food, shelter, shots, altering, A.V.I.D. microchips, etc.?: If Yes, initial here: _________

Do you further understand that the Central Valley Collie & Sheltie Rescue makes no warranties concerning the temperament, habits, or background of any dog you may choose and that all adoptions are based solely on your own judgment?: If Yes, initial here: _________

Signature of Applicant: _________________________________________ Date: _________________

Deposit must be paid in cash only: $__________ Balance due on delivery: $__________

Total cost of dog is: $______________

Dog's breed: ___________________________ Dog's name: ___________________________


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