Pet Adoption Application Form

Pet Adoption Application

Prospective Pet Parent*

First NameLast Name

Name of Pet You Wish to Adopt*

Email Address*

Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Do you own any pets?*

YesNo

Pet Name(s)

Pet Breed(s)

Pet's disposition and behavior towards other dogs and cats?

List your veterinarian's name, address and telephone number: *

Do you own or rent your home?*

OwnRent

Do you have a yard?*

YesNo

If "Yes" to the above, is it fenced? please describe

What is your landlord's pet policy?*

If you rent, please provide landlord's contact information: (name/phone number):*

Have you ever surrendered or rehomed a pet?*

YesNo

If you answered "Yes" to the above question, please provide details:

List how many children are in the home and their ages:*

How many hours per day would the pet be alone?*

Will you crate your pet?*

If you have to leave town, emergently or planned, where would your pet stay?*

How would you deal with behavioral issues such as barking, chewing, destructive behavior, bathroom accidents indoors, unruly leash behaviors in your pet?*

List three (3) personal references: [Include name, phone number and email address for each.]*

Have you ever been convicted of an animal-related crime, such as cruelty to animals, animal theft, or animal abandonment?*

YesNo

If you answered "Yes", please provide a detailed description:

By clicking the submit button, I agree to all of the following:

I authorize Old Drum Animal Shelter to check references including veterinary and personal.
I understand there is no "cooling off" period, and that if I no longer want, or can no longer care for, my adopted pet--I agree to notify Old Drum Animal Shelter immediately to surrender the pet and to provide a 14-day period to allow Old Drum Animal Shelter to make arrangents (i.e. kennel space) for my pet to be returned. I also agree to transport the pet back to Old Drum Animal Shelter and understand a surrender fee will apply.
I understand that the shelter makes no warranties regarding the health of this animal. I agree to take the animal to a veterinarian for evaluation promptly.
I accept the animal as is, and I assume all risks of ownership of the animal. I release Old Drum Animal Shelter from all liability for any damage or injury which the animal may cause to any person or property.
I understand and agree that some, or all, of the information regarding the animal may have been received by Old Drum Animal Shelter from third parties and Old Drum Animal Shelter does not warrant the accuracy of such information.
I understand that pets are a lifetime commitment and that even though my life, location, job, housing, etc. may change, it is my intent to make my pet a part of that change.
I understand that, typically, the animals available for adoption from the shelter lack a complete history, and the shelter cannot guarantee health or personality of any animal adopted from the facility.
I understand that all advice given by Old Drum Animal Shelter staff regarding animal care/behavior is based on professional experience, and that I should follow up with my veterinarian or a professional dog trainer regarding health and behavior problems I may experience in my home.
I understand that the shelter intends to place each animal in the appropriate home, and therefore, reserves the right to refuse adoption to me at any time during the process for any reason.
I am fully aware that I am adopting a living creature, and as such, there will likely be a period of time that this animal needs to adjust to my home. I also understand that Old Drum Animal Shelter is unable to guarantee the health of any animal. If this animal becomes ill, I certify that I am financially and/or emotionally prepared to treat this animal at my own expense.
I verify all information provided in this application is true and accurate. I certify that I am at least 18 years old of age. I understand any misrepresentations of facts may result in my losing the privilege of adopting a pet.

Signature of Prospective Pet Parent*