Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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-
Area Code
Phone Number
Email address
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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. Do NOT add a family member/relative! Preferred: Veterinarian reference along with one other reference.
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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?
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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?
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Yes
No
How many people are in your household?
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What are the ages of the people in your household?
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Where do you live?
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House
Apartment
Condo/townhouse
Other
Do you own or rent?
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Own my own home
Rent
Live with parents or homeowner
Other
If you rent or live with a parent, grandparent, in college, etc, provide the name and phone number of your landlord.*Required if you do not own your home*
I am interested in a:
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Cat
Dog
How many hours will your pet be left alone each day?
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1-2 hours
3-4 hours
4-6 hours
8-10 hours
10+ hours
Other
Why are you interested in adopting a pet? (check all that apply)
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Companion
Child's pet
Gift
Guard dog
Company for Other Pet
Other
This animal will primarily be kept:
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Indoors
Outdoors
When outdoors, this animal will be confined:
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In a fenced area
On a tie-out
In a kennel
Other
Do you have any animals in your home currently?
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Yes
No
If yes, do what kind of animals do you have in your home?
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Cat
Dog
Other
Length of time with you:
Is this animal(s) still with you?
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Yes
No
Are all of your animals spayed/neutered?
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Yes
No
If not, please explain why:
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Name of Veterinarian Clinic:
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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 understand they may not be able to take said animal back and I will need to rehome the animal myself. If the dog/cat is returned, and I may have to pay a surrender fee. I understand that no refund monies shall be returned to me. I have read, understand, and agree to this statement.
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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.
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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. Adoption Cancellation: I understand that if I do not pick up my animal on the day agreed and do not contact PPHSC within 24 hours of said original pick-up time or if I fail to show-up for pick up of said animal, I forfeit my adoption and the animal will be placed back up for adoption. I also understand that Precious Paws reserves the right to deny my application/contract for any reason and I understand they are not required to give an explanation on why I was denied
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I agree
Please print name and date:
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