Clover Patch Sanctuary - Clover Patch Sanctuary

In our efforts to be 100% Eco-Friendly, we ask that you fill out our adoption application here through our website. If you do not feel comfortable with doing that or are unable to do that, let us know by calling 615-473-1803 and we'll print you a paper application.  

Please Note:  All applications and/or contracts will be reviewed by Clover Patch Sanctuary.  A member of our staff will contact you via email or phone. 



ADOPTION APPLICATION/CONTRACT
Date:
Adopting
Rabbit
Guinea Pig
Bird/Waterfowl
ALL OTHERS
Full Name Of Applicant:
Phone Numbers (Work, Home, Cellular):
Address:
Email Address:
Birthday:
Drivers Liscense #
State of License:
Reference (Include Phone Number):
How Did You Hear About Us? (Check All That Apply)
Internet
Media (Newspaper, Magazine, TV)
Word of Mouth
Event
Number of Animals Currently In The Home:
List The Names/Ages/Breeds/Type of Animals Currently In The Home:
How Will You Keep Current Animals In The Home From Harming/Hurting Your Adopted Animal?
Have You Ever Had A Rabbit/Guinea Pig/Small Animal/Bird/Waterfowl As A Pet Before?
Yes
No
If You Answered "Yes" Please Explain Why The Animal(s) Is No Longer With You:
Who Will Be The Primary Caregiver Of The Adopted Animal(s):
What Room Of The Home Will Your Adopted Animal(s) Live In?
Do You Own Snakes Or Other Retiles?
Yes
No
If You Answered "Yes" Please Tell Us The Type Of Reptile(s) You Own:
Have You Ever Bred Animals?
Yes
No
If You Answered "Yes" Please Tell Us The Type Of Animal(s) You Have Bred:
Are You Adopting This Animal(s) As A Gift?
Yes
No
If You Answered "Yes" Please Tell Us For Whom:
Please List The Names & Ages Of Other Persons Living In The Home:
Do You...
Own Your Home
Rent Your Home
Live With Family/Friends
If You Rent Your Home OR Live With Family/Friends, Please Provide Their Name & Number:
Is Your Home...
One Story
Two Story
Please Provide The Name & Number Of The Veterinarian You Intend To Take Your Adopted Pet(s) To:
Are You Agreeable To Periodic Home Visits And/Or Phone Calls By A Member Of Our Staff To Check On The Welfare Of Your Adopted Pet(s)?
Yes
No
Do You Agree That If You Move From Your Current Address or Out-Of-State That You Will Notify A Member Of Clover Patch Sanctuary Of Your New Address & Phone Number?
Yes
No
Do You Agree To Contact Clover Patch Sanctuary If Your Adopted Pet(s) Die?
Yes
No
Do You Agree To Contact ONLY Clover Patch Sanctuary If You Wish To Surrender Your Adopted Pet(s) & ONLY Surrender Your Adopted Pet(s) To Clover Patch Sanctuary?
Yes
No
Do you agree that neither you or any other person(s) will punish this adopted pet(s) with corporeal punishments, spankings, deprivation of food/water or isolation or ANY punishment since that is cruel and you will ONLY use positive reinforcement with your adoptive pet(s).
Yes
No
Do you agree to treat this adopted pet(s) as a member of the family with all the rights and privileges that you would give to dogs/cats.
Yes
No
You are aware and willing to spend approximately $30-$40 per month on supplies, food and activities for your adoptive pet(s) and that amount does not include vet visits
Yes
No
You agree to take your adoptive pet(s) to a qualified veterinarian once a year for a check-up even if your adoptive pet(s) seems perfectly healthy.
Yes
No
You are willing to hire a pet sitter if/when you travel and will NEVER leave your adoptive pet(s) unattended during a vacation or trip
Yes
No
You will seek medical attention immediately for your adoptive pet(s) if he/she/they become ill.
Yes
No
You agree to provide proper grooming for your adoptive pet(s)
Yes
No
You agree to house your adoptive pet(s) properly in accordance to the guidelines set up by Clover Patch Sanctuary
Yes
No
You agree (if adopting a rabbit(s), guinea pig(s), small furry(ies) that you will never house your adoptive pet(s) outdoors for ANY REASON & any adoptive furry pet(s) adopted from Clover Patch Sanctuary will always be supervised during playtime outdoors by a person(s) over the age of 18 years old
Yes
No
You understand and accept that Clover Patch Sanctuary and/or any of its members and/or directors are not responsible for your adoptive pet(s) medical care cost(s)
Yes
No
You agree and accept that you must keep your adoptive pet(s) habitat clean in accordance with the proper guidelines provided by Clover Patch Sanctuary as this promotes good health for your adoptive pet(s)
Yes
No
RABBITS & GUINEA PIGS ONLY: You agree to feed your adoptive pet(s) unlimited amounts of grass hay as this promotes good health
Yes
No
GUINEA PIG ADOPTERS ONLY. You agree to suppliment your guinea pig(s) diet with appropriate vegetables containing Vitamin C
Yes
No
You will strive to make your adoptive pet(s) your companion and incorporate him/her/them into your home just as you would a dog or cat
Yes
No
You agree that you will ONLY pick up your adoptive pet(s) in the appropriate way as explained and demonstrated by Clover Patch Sanctuary
Yes
No
You fully understand that the animal(s) you are adopting are fragile creatures and must be handled respectfully. Therefore you agree and accept that you will alway supervise your adoptive pet(s) around children or persons under the age of 18 years old
Yes
No
You acknowledge and agree to the adoption fees charged by Clover Patch Sanctuary and that NO refunds are given on adoptive pet(s) when returned to Clover Patch Sanctuary.
Yes
No
DUCKS ONLY: You agree to provide an adequate water source for your duck(s) being adopted from Clover Patch Sanctuary
Yes
No
DUCKS & CHICKENS ONLY: If housing outdoors, you agree to provide predator-proof housing for your duck(s) and/or chicken(s) being adopted from Clover Patch Sanctuary & promise to always house them at night to protect said birds from predators?
Yes
No
DUCKS & CHICKENS ONLY: You agree to feed your duck(s) and/or chicken(s) a healthy and balanced diet and never feed grain or bread products as this is unhealthy for said birds
Yes
No
DUCKS & CHICKENS ONLY: I pledge that I am adopting said duck(s) and/or chicken(s) from Clover Patch Sanctuary as PETS ONLY and I will not slaughter nor eat them
Yes
No
ALL ADOPTERS: You agree that you are adopting said animal(s) from Clover Patch Sanctuary as PETS ONLY and never will slaughter and/or eat them.
Yes
No
You agree and accept that if ANY of the terms or condition of this contract are not met, that Clover Patch Sanctuary will reclaim your adoptive pet(s).
Yes
No
You understand and accept that Clover Patch Sanctuary Inc. has the right to refuse any adoption contract submitted to them.
Yes
No
If you answered "No" on any of the above questions, please explain:
By typing your name in the box below, you are verifying and accepting that the information answered by you in the questionnaire/contract is truthful and that this document is a legal and binding document between yourself and Clover Patch Sanctuary Inc.








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