ADOPTION FORM

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Email

example@example.com

Who will be responsible for this pet

Adopter Age(required)

Adopter Facebook ID(required)

Residence Type?(required)

Do you: Own Rent Live with parents/relative/guardian

If renting,does your landlord allow pets

How long have you lived at your present address

Landlord’s Name

Landlord’s Phone No

Do you anticipate moving within the next six months

If you move sometime in the future/ are getting married; what will you do with your pets?

Where are you from(required)

Bachelor or Family?(required)

If there are kids at home, number of kids and their age(required)

Do all adult members of the household know that you plan to adopt a pet

Name(s)of other adults in household

Any family member allergic to animals?(required)

Any Previous Pet Experience?(required)

What happened to them?

Number of other Pets currently? What Kind- Dog/ Cat/ Bird/ Fish others?(specify)

please provide the following information on your animals:Kind/ Animal’s Name /Sex/ Age /Time Owned /Spayed/Neutered

Are all your pets current on their vaccinations?

What is the name your veterinarian/clinic?

Why are you adopting a Pet?(required)

How many hours/day will this pet be alone?(Without human companionship)

Where will this pet be during the day & at night?

Is there somebody who will be in the house to take care of your pets in your absence/ if you are out of town?(required)

Would you allow the current foster parents to see this pet in its new home?Yes No

Convenient time for House Check?(required)

Are you aware of the financial commitment and responsibilities of owning a companion animal?(Cost for food, vaccinations,etc.,not including emergency medical care.) Yes/ No. Are you willing to spend this much or more?

Profession?(required)

Place of Employment

Any reference from Pet lover / Activist? Please mention details(required)

Are you aware that having a pet is a responsibility for 10+ years (Lifetime)(required)

Driver’sLicense/Identification Card No

Terms and conditions:
I,hereafter referred to as the adopter,hereby agree that the above described pet is being
adopted by me solely as a pet for myself and/or my immediate family.I am not a breeder and I
will never use the pet for breeding purposes.
I agree not to abandon, giveaway, sell, transfer, foster out or dispose of the pet in any way, and
to not the current owner(s) immediately at any time I determine I no longer want,or can no
longer keep the said pet ,so that the current owner(s)can take the said pet back to arrange
another adoption.The Current Owner(s)shall have the right of first refusal and must be notified
first of any decisions regarding placement of the pet.I agree to give the Current Owner
reasonable time to find the pet another foster home and understand that this may take a few
weeks.
I hereby agree to care for the above described pet in a humane and responsible manner and to
provide it with clean and adequate shelter, exercise, food, water and proper veterinary care
through a licensed veterinary doctor. I further agree that the said pet shall reside inside my
home and shall not be allowed to roam freely.
I further agree to allow a representative(s) of the current owner to visit my premises from time
to time to ensurethat thesaid pet is being well looked after. If for any reason the said
representative(s) are not satisfied with the level of care being met out towards the said pet,the
said representative(s)will have absolute authority to remove the pet from my care.In the event
of a change of address I will inform representatives of the current owner of the same.
In the event the said pet is critically ill or expires,I agree to promptly inform the current owner(s)
of th esame.
I further agree to obey all the laws of the land as mentioned in the Animal Protection Laws
Section11 IPC andupon violation of any of these laws will be liable to be sued in the Court of Law.

I hereby certify that I agree to the above terms and conditions.

Signature