HSYC Adoption App and Contract

Humane Society of Young County Adoption Application and Contract

Name of animal interested in (or type/breed):

Dog or Cat?

Breed or mix

Date

Adopter:

Phone Number

Area CodePhone Number

Physical Address:

City

State

Zip Code

Driver's License

Email:

example@example.com

Employer:

Hours worked per week:

If renter: Landlord name:

Landlord Phone number:

New pet live indoors or out?

have a fenced yard?

If yes, what type/Height?

All members of the family agree on bringing a new pet into the family?

Names & Ages of people living in the home:

Current/ past vet?

Veterinarian Phone Number:

If no vet history, please put the vet you plan to use.

List current pets: Name/dog or cat/age/vaccs current?/ Spayed or Neutered?

If current pets aren't vaccinated or spayed/neutered, why not?

Have you adopted from us before?

YesNo

Date:

Date

Name of previously adopted dog(s)/cat(s):

Pet History -list pets you no longer have and why? (Please be Specific) If you are a first time pet owner please say so.

Please list 2 references not related to you: 1. Name & Phone:

2. Name & Phone:

If you move in the future, what will you do with your pet?

What activities are you interested in doing with your pet?

Are you willing to housetrain your new dog? Are you familiar with crate training?

Are you willing to seek help with training if needed?

Are you prepared to care for this pet for the remainder of its life, possible 10-15 yrs?

Are you familiar with heartworms and plan to use preventative for your dog?

Do you plan to regularly use flea/tick preventatives?

Do you plan to keep vaccinations up-to-date according to state laws and your vet's recommendations?

Do you agree to provide nutritious food, clean water, and needed grooming for your dog/cat?

Since declawing has been proven to cause chronic pain and behavioral issues in some cats, I agree that I will not have this cat declawed, and will seek alternative options if I need to stop the cat from clawing on furniture, etc.

Do you agree to return your dog/cat to HSYC if you are no longer able to provide for its care?

If not previously done, do you agree to return the dog/cat at the specified date/time/place for spay/neuter surgery?

Humane Society of Young County

Adoption Application & Contract

I certify that I have read and agree to abide by the provisions in this contract and that the statements made in my application are all true and correct to the best of my knowledge. I agree that I shall be in breach of this contract if I fail to perform any of my obligations under the provisions of this contract or if any statement or representation made by me to the Humane Society of Young County (HSYC) is proven false when made.

In the event of such breach of contract, HSYC shall be entitled to immediate possession of the pet and has the authority and my permission, without notice to me, to enter my premise or any premise where the pet may be and take possession of said animal. The animal shall not be returned to me nor shall I be entitled to any refund in the event of any breach of contract.

I understand that this contract contains the entire agreement of the parties and no other statements or promises made by the HSYC, it's agents or employees which are not contained herein, shall be binding or valid.

I understand that the temperament, pedigree, and health of this animal may not be fully known and do hereby assume full responsibility for said pet. I understand that pets can be unpredictable and children should always be supervised around animals.

I accept possession of title to (subject to the conditions in this adoption contract) and responsibility for the animal indentified above and release and discharge HSYC forever from all liability for any injury or damages to any person or property caused in the future by said animal and from any cause of action, suits, or demands whatsoever that may arise as a result of such injury or damages.

I am allowed a 5 day trial period before finalizing this adoption. If this pet does not fit into my home and I return the pet within 5 days I will be refunded my adoption fee at the discretion of the shelter director. After 5 days, no refund will be given, though the animal is still required to be returned to HSYC if I am no longer able to care for them. I am required to return any vet records along with said pet or a $25 fee will be withheld from my adoption fee refund.

Should the animal I adopt, not be spayed/neutered at the time of adoption, I understand that I am to return the pet on the day, time, and to the place specified for the spay/neuter surgery. I also understand that should said animal be or become pregnant, any offspring of the animal immediately become the property of HSYC and the disposition of said offspring will be at the discretion of HSYC. Furthermore, should an animal that is being "readopted" by a previous owner not be presented for spay/neuter per the requirements of the HSYC and/or Animal Control any and all city and HSYC fees, citations, etc that were dropped will again become valid.

Date/Time/Place to drop said animal for spay/neuter:

By signing below I attest that all the information I have given in my application is correct to the best of my knowledge and that I agree to the provisions set forth in the above contract. Further, I understand that incomplete applications can slow the process or cause my application to be denied. I also understand that dishonest answers on my application will cause my app to be denied: Signature:

Date:

HSYC Signature:

HSYC USE ONLY:

ID Check

Landlord Check

Vet Check

Comments:

Conditional approval requirements:

Results:

ApprovedConditional Approval--Requirments that must be met:Denied Application--Reason:

Date:

Date

Staff member signature: