Precious Paws Animal Adoption Application

Name *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number *

Area Code Phone Number

Email address *

Please upload a picture of your driver's license or ID.

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If you do not have a driver's license or ID, please explain why:

Please list the name and phone numbers of 2 references. Family and friends cannot be references. Preferred: Veterinarian reference along with one other reference. *

Are you interested in a specific pet that you have met at the shelter or seen on our website? Please let us know who your top choices are.

Do you currently have pets in the home? *

No Yes

If you do have pets in the home, please describe them:

To adopt an animal, you must be at least 18 years of age, have the consent of all adults living in the household, have verifiable identification, have landlord's consent (if renting), be familiar with your local animal ordinances, be able to afford veterinary/daily care, and pass our screening process. Do you agree to this? *

Yes No

How many people are in your household? *

What are the ages of the people in your household? *

Where do you live? *

House Apartment Condo/townhouse

Do you own or rent? *

Own my own home Rent Live with parents or homeowner

If you rent, provide the name and phone number of your landlord.*Required if you do not own your home*

I am interested in a: *

Cat Dog Type option 3 Type option 4

How many hours will your pet be left alone each day? *

1-2 hours 3-4 hours 4-6 hours 8-10 hours 10+ hours

Why are you interested in adopting a pet? (check all that apply) *

Companion Child's pet Gift Guard dog Company for Other Pet

This animal will primarily be kept: *

Indoors Outdoors

When outdoors, this animal will be confined: *

In a fenced area On a tie-out In a kennel

We recommend that you take your new pet to your veterinarian for a wellness check within one week of the adoption date. Please note: once adopted, all medical expenses for this animal become your responsibility. *

I agree I don't agree

Do you have any animals in your home currently? *

Yes No

If yes, do what kind of animals do you have in your home? *

Cat Dog

Length of time with you:

Is this animal(s) still with you? *

Yes No

Are all of your animals spayed/neutered? *

Yes No

If not, please explain why: *

Name of Veterinarian Clinic: *

If for some reason, this adoption does not work to the advantage of me/my family and the animal, I agree to contact Precious Paws Humane Society and give them first option to re-acquire the animal before any further placement or euthanasia is attempted. I agree that I shall not transfer ownership of the animal unless Precious Paws Humane Society elects not to exercise this option within 5 business days of my notifying them of my wish to return the animal. If the dog/cat is returned, I understand that no refund monies shall be returned to me. I have read, understand, and agree to this statement. *

I agree

Failure to fulfill this stipulation of this application (such as, but not limited to, falsifying information, verified animal neglect/cruelty/mistreatment) will result in forfeiture of the adopted animal back to Precious Paws Humane Society. I have read, understand, and agree to this statement. *

I agree

Purpose of this agreement: This form releases Precious Paws Humane Society of Chisholm (PPHSC) from all liability and risks posed in the act of an interested party meeting with an animal owned by PPHSC. Release of Liability: I agree to bring no action or claim against PPHSC or their officers or agents, by reason of this visit. If this is a "meet and greet" involving an animal I own, I understand that I am responsible for my animal's actions. I understand that PPHSC is not making any representations or warranties about any animal's temperament or behavior. I acknowledge and agree that PPHSC is not responsible for any injury, damage, or harm caused by any animal and I hereby release PPHSC from any and all liability for any injury, damage, harm, expense or liability I incur. I also agree to indemnify PPHSC from any and all such claims and to pay, without limitation, any costs related to such injury, damage or liability, including the case of litigation, any attorney's fees incurred by PPHSC in its defense. Assumption of Risk: I acknowledge that meeting with any animal can post a risk to my safety and the safety of any minors accompanying me. Such dangers include, by way of example and not limitation, the risk that the animal can bite, trip, and knock down people, especially children, and can fight with other animals. I also understand that if an animal I own is taking place in a "meet or greet," PPHSC is not liable for any injuries or damages that my animal sustains. Accordingly, the undersigned(s) assumes the risk of injuries, losses, damages, costs, and expenses of any sort due to this visit. I understand and agree that PPHSC shall not be held responsible for the same. I hereby declare that I have fully read and understand the terms of this release, and release PPHSC from all liability for myself, any animal I may own, and minors accompanying me. I agree to sign this form in person when approved. *

I agree

Please print name and date: *