Adoption Attestation and Agreement

First Name*
Last Name*
Email Address*
I attest that I am at least 21 years of age*
- Yes
- No
I attest that if I am 80 years old or over and live alone, I have a plan in place for support if for whatever reason I need help with the dog*
- Yes
- No
I attest that I have not been convicted or found guilty of animal cruelty, neglect or abandonment, or of failing to provide adequate shelter to an animal.*
- Yes
- No
I agree to comply with all City, County, State and Federal rules as they apply to dog ownership.*
- Yes
- No
I agree to contact Cairns & Cousins Terrier Rescue (CCTR) if I can no longer keep this dog.*
- Yes
- No
I agree to allow my references to be contacted and a CCTR volunteer to complete a home safety inspection by appointment*
- Yes
- No
I agree to never allow my dog to be off leash in an unsecured area*
- Yes
- No
I agree never to use an e fence as primary containment for my dog*
- Yes
- No
- Donation Fees
  
  Puppy up to 1 year $600
  Teenager one day over 1 year to 3 years $550
  Adult one day over 3 years to 6 years $450
  Mature one day over 6 years to 9 years $325
  Senior one day over 9 years to 12 years $175
  Very special senior one day over 12 years $75
- I am able and willing to make a donation if I adopt a dog from CCTR.*
  - Yes
  - No
- Age ranges for people and limitations on adopting or fostering
  
  21-70 no restrictions
  One day over 70- 73 no puppies
  One day over 73 - 75 no dog younger than 3
  One day over 75 - 78 no dog younger than 6
  One day over 78 and up no dog younger than 9
- I agree to CCTR age policy*
  - Yes
  - No
I attest that the information provided on this application is the truth to the best of my knowledge. I/we hereby give my/our permission to CCTR to use any of the information in this application to confirm its accuracy.*
- Yes
- No
After you submit the attestation and agreement, you’ll be directed to the adoption application.

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