We are a Non Profit 501C 3 Rescue saving dogs from the Euthanasia list! "Chi Town" is short for "Chihuahua Town," which is our nick-name. Chi Town Rescue saves small dogs who require a little extra TLC. Many of these dogs are Chihuahuas or Chi mixes, hence our name! These dogs may not be doing well for a variety of reasons- fear, fear aggression, anxiety, or a medical needs to name a few. Dogs that have no other outlet make up most of our residents. After our dogs are medically cleared and/or their behaviors have improved and we’ve learned how to manage the behaviors, we make them available for adoption. Our dogs leave Chi Town Rescue as well adjusted as possible and fully vetted.

Adoptions fee's are $75 to $600 dollars. We do home inspections before adoptions, meet and greets with other animals in the home.

Chi Town Rescue

Adoption Agreement (please print legibly)

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Adopter’s Name __________________________________________________Phone: ________________________

Co-Adopter’s Name________________________________________________Phone: ________________________

Street Address: (no PO box) _______________________________________________________________________________________________________

City: ____________________________ State _________ Zip _________ Email: _____________________________________

Dog’s Name _____________________ Breed_________________________ Male ___ Female ___ Approx. Age _______

Non-refundable adoption fee $___________

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Initial below to indicate that you understand and/or agree to the following:

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The adopter of this dog understands that the Chi town Rescue has completed all medical treatment needed for said dog to date. Chi Town Rescue makes every effort to adopt out only healthy animals. All tests and/or treatments given to this dog prior to adoption were given based on our veterinarians consultation when/if symptoms warranted.

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________ Tick and valley fever are prevalent in the Phoenix area and blood tests can be done to confirm the dog’s titer score. We have provided information about veterinarians on your take home information sheet that do these tests at reasonable costs and upon symptoms of these diseases. I understand Chi Town Rescue only tests for these diseases when symptoms have shown themselves when a dog is in rescue.

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________ I understand Chi town Rescue takes all precautions possible to prevent and eradicate any parasites prior to adoption but that ticks, giardia, kennel cough, diarrhea and worms are common in shelter dogs and can only be treated when symptoms appear.

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________ I am a least (18) eighteen years of age and I acknowledge that there are many risks associated with being around dogs, including though not limited to, the risks of being bitten, scratched, jumped on, knocked over, chased, tripped, infected with a disease, injured, frightened, receiving a life threatening injury, sustaining property damage, and incurring liability of a dog’s actions.

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________ I acknowledge Chi Town Rescue cannot make any guarantees of a dog’s health or behavior, and that they cannot control or prevent dogs from causing injuries or damages.

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________ I agree not to use any force to discipline the dog including hitting or any other injurious treatment, and to use humane obedience training. I will consult Chi Town Rescue immediately with any training concerns and/or seek advice from a qualified trainer, if necessary.

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________ I have been made aware of any and all history known of this dog by Chi Town Rescue. I understand that any age information is a best guess since we seldom have any verification of birth date.

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________ I understand my adoption photo may be used to announce my new dog’s adoption on social media such as but not limited to Facebook or as part of a collage of adoption photos for our adoption center.

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________ I agree to give this dog proper food, shelter, fresh water, and a yard with a fence to keep him/her in my care and control at all times. I agree NOT to chain or similarly restrain the dog or leave the dog outside unattended. If living in an apartment or condo with no yard I will provide the dog with sufficient means of exercise.

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________ I agree to provide vet treatment when necessary and at my own cost, including but not limited to booster shots and rabies vaccines.

(OVER)

________ I agree to license my dog with the city/county of residence.

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________ I acknowledge that Chi Town Rescue place pets as Family Pets Only. I understand that legal action will be taken against me should the dog be used for any other purpose.

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________ I agree that my dog will be a house dog and will be allowed to sleep in the house at night.

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________ I agree to return the dog to Chi Town Rescue if for any reason I am no longer able to keep it. If the return of the dog becomes necessary, I agree to call Chi Town Rescue to facilitate the dog’s safe return. I also agree I will not sell or give the dog to another person, company or animal shelter. Any fees incurred to Chi Town Rescue to recover the dog from any other person, company or animal shelter will be the responsibility of the adopter and legal action will be taken if required to recover those costs plus the legal costs.

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________ I agree to keep personalized identification tags on the dog at all times, and on a leash when in public. I also agree I will not transport the dog in an open vehicle.

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________ I agree to notify Chi Town Rescue immediately if the dog is lost and agree to follow directions from the rescue as how to recover the dog.

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________ I understand that the money given for the adoption of the dog is a gift voluntarily made and does not represent a purchase price. I understand that my donation is used to partially offset the expense incurred by the rescue in the acquisition, housing, vet treatment and feeding of the dog. I understand this is non refundable even if the dog is returned.

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________ I understand and agree that I will be liable for all court costs, attorney’s fees and any other reasonable expenses incurred by Chi Town Rescue as a result of my failure to comply with any provision set forth in this agreement.

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________ I understand that I am totally responsible for any and all expenses incurred after the adoption of this dog.

By my signature below I agree that I will not hold Chi Town Rescue, responsible for any damage or injury sustained by the adoption of this animal. I certify that I have ready and fully understand the provisions of this contract and I agree to abide by all provisions completely.

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Printed Name___________________________________________________________________________

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Signature____________________________________________________________________ Date: _____________________

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Chi Town Rescue

PO BOX 37946

Phoenix, AZ 85069

(602) 214-6942

chitownrescue@gmail.com

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Chi Town Rescue

Adoption Application

602-214-6942

chitownrescue@gmail.com

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Applicant’s Name: Phone: Home Cell Work

Co-Applicant’s Name: Phone: Home Cell Work

Address (no PO Box): City: State: Zip: E-Mail: In what type of housing do you reside? Apt/Condo House Other: Own Rent Landlord’s Name (if you rent): Phone: Does your Landlord/HOA/City have any breed restrictions that include the pet you are considering to adopt? Yes No

Do you plan on moving in the next 12 months? Yes No If Yes, to: Apt/Condo House Other: If yes, what do you plan to do with the animal? Why do you want to adopt this pet? Companion for self Companion for child Companion for other pet(s)

Security Working dog/mouse chaser Breeding

Other: Energy level preferred: High Medium Low

I intend to (check all that apply):

Walk dog on a leash Walk dog off leash Bring dog to a dog park

Hunt with the dog

Go jogging or hiking with the dog

Let the dog exercise himself in the yard

Are all members of your household in agreement about adopting a dog? Yes No

Do any members of your household have asthma, or have allergies to dogs? Yes No Describe your household activity/noise level: High Medium Low

In the event of an emergency, who would care for your dog or

what arrangements would you make? Is this pet a gift for someone? Yes No If yes, who? Have you previously owned pets? Yes No

List all pets you have owned in the last 5 years:

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Name

Breed

Sex Spayed/ Neutered? Current on Vaccinations? Do you still own it?

If not, why?

If more space is needed, please write on the back of this form or write it in the email you attach this form to.

List all veterinarians you have taken your pets to in the last 5 years, including the veterinarian you plan to use for this pet:

If more space is needed, please write on the back of this form or write it in the email you attach this form to.

Do you grant permission to Chi Town Rescue to contact your vet(s)? Yes No

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Name of Pet Being Adopted: Breed: Male Female Altered? Yes No Vaccines Current? Yes No Micro-chipped? Yes No Age:

Are you experiencing any difficulties with your current pets in terms of health or behavior? Yes No

If yes explain:

Have you ever given a pet away, given it to a shelter or rescue group, returned it to a breeder or sold it? Yes No

If yes explain:

Some dogs require a period of weeks or even months to adjust to their new home/environment/family/other pets. Are you willing to allow for this adjustment period? Yes Not Sure No, I prefer a pet who will adjust quickly

Are there any children in your household or children who visit frequently? Yes No

If Yes, what are their ages?

In general, what types of discipline/corrections do you use with a pet?

Will you be using a crate for the purpose of training? Yes No

Do you have a fenced yard? Yes No If Yes, how high? What materials?

What percentage of time will this pet spend: Indoors? Outdoors?

When this pet is outdoors, how will s/he be kept? (fence, chain, line, kennel, etc.)

On average, how many hours a day will this pet be left alone during the day?

Where will this pet be kept while you are away from home during the day? (crate, yard, bedroom, garage, etc.)

Where will this pet be kept while you are out of town?

Are you willing to provide your pet with monthly heartworm prevention medicine? Yes No

Are you willing to provide your pet with annual vaccinations? Yes No

Who will be financially responsible for all medical costs?

List any characteristics of an animal that would NOT fit with your family or lifestyle:

What circumstances might justify giving up a dog? (check all that apply)

None Allergies Baby Behavior problems Children lost interest Destructive Divorce Dog becomes ill Dog bites someone Dog not getting along with other pets House soiling/urine marking

Life change such as new/lost job Moving New household member dislikes dog Shedding Too time consuming Want to travel Other:

If your new dog exhibits behavioral or adjustment issues, would you be willing to seek the advice of a Chi Town Rescue rep. or a

professional dog trainer? Yes No

Would you be willing to pay for obedience or behavioral sessions, if needed?

Please provide two personal references NOT related to you:

Name: Phone:

Name: Phone:

Please include any information you would like for us to consider when reviewing your adoption application for approval:

For Office Use Only

Approved Declined Adoption Fee Paid: Initials: Date: