FIRST NAME:  M.I.:  LAST NAME:

STREET ADDRESS:

CITY:  State :

HOME TELEPHONE NUMBER:

NAME OF EMPLOYER:

WORK TELEPHONE NUMBER: 

VALID EMAIL ADDRESS, (IF APPLICABLE):

AGE:

DRIVERS LICENSE NUMBER AND STATE:

Do you agree to absolve Valley of the Sun Dog Rescue and all of it’s representatives from any liability in reference to any dog adopted? No Yes

Do you agree that the dog will not be used in any illegal or harmful activities? No Yes

Do you agree to keep adopted dogs out of municipalities and areas where their presence is illegal? No Yes

Do you agree that the dog(s) are to be kept as house pets and that it, they, shall not be the subject of used in medical or any other experiments? No Yes

Do you agree that the adopted dog(s) shall not be trained for not participate in any of the “Blood Sports”.  This includes, but is not limited to fighting, bull or bear baiting or any other acts of a cruel and vicious nature that may bring harm to the dog? No Yes

I have read and understand the above statements, and have given my agreement by submitting this form. A written document will be provided for signing at time of adoption.

Now that the formalities are over lets choose a companion.

Please select which companion you are interested in. Tucson Rescues Beagle/Bassett/Heeler Mix (10wks) Boxer Mix (9 wks) Sedona Bo Sweet Pea Bubba Tilly Pit Bull (4 wks) Japenese Chin (4 wks) Shitzu/Poodle Mix (6 wks) Beagle/Basset (2 years) Trixie Lola Sheltie Dolly Pit bull Mix puppies

Please tell us a little about yourself.