In order to be considered as an adopter today, you must meet the following requirements. Please initial each showing that you understand.
1 | F O N D D U L A C H U M A N E S O C I E T Y – D O G A D O P T I O N A P P L I C A T I O N
(by providing your veterinarian information you are allowing FDL Humane Society to contact your vet, please contact your vet to authorize the release of appropriate information to FDL Humane Society)
2 | F O N D D U L A C H U M A N E S O C I E T Y – D O G A D O P T I O N A P P L I C A T I O N
About the dog you wish to Adopt:
Names of the Fond du Lac Humane Society Dogs You wish to Adopt:
What is your Ideal dog and why?
Personal References #1 (Please List A NON-RELATIVE);
Personal References #2 (Please List A NON-RELATIVE);
By signing below, I certify that the information I have given is true and that I recognize that any misrepresentation of facts may result in my losing the privilege of adopting a pet. I understand that FDLHS has the right to deny my request to adopt an animal and I authorize investigation of all statements in this application.
ALL INFORMATION CONTAINED IN THIS APPLICATION WILL REMAIN CONFIDENTIAL AND THE PROPERTY
OF THE FDLHS. All Dogs MUST have a leash, before they can leave the shelter. *As a FDL Humane Society
applicant, I understand that I will be handling animals. I understand that in handling animals I may undertake any number of risks. I understand that in assuming this I may be exposing myself to potentially significant health risks or serious medical conditions, including, but not limited to: injuries from slips and/or falls, bites and scratches, infectious diseases, parasites, and allergic reactions (e.g. rabies, fleas, ringworm, and asthma Approved Applicant Waiver *Since many animals that come to the FDL Humane Society are from unknown backgrounds and are therefore ultimately unpredictable, I am thus aware that the FDL Humane Society is not in a position to know and makes no representations with the temperament, health or condition of any animal. In particular. I must rely on my own judgment and I understand and agree that by handling the animal, as an applicant I do so at my own risk. *Therefore, I agree to hold harmless, the FDL Humane Society, its employees, volunteers, agents, or directors, whether collectively or individually, for any injury or liability the animal(s) may cause to me. I further assume any and all liability for damages or to other persons, which may be caused by any animal(s) while in my care as an applicant, and hold the FDL Humane Society harmless therefrom. Please Print
4 | F O N D D U L A C H U M A N E S O C I E T Y – D O G A D O P T I O N A P P L I C A T I O N