Animal Control Adoption Application

Applicant Information
Applicant's Name*

First NameLast Name
Applicant Date of Birth*

MonthDayYear
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Physical Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

I, the undersigned, do hereby agree to the following terms and conditions stated below:

I understand that White County Animal Control will only accept the animal back if I am a White County
resident. Should I not be able to keep the animal I have adopted, and I am not a citizen of White
County, I will need to contact the local rescue groups and/or the local animal control agency;

I understand that White County Animal Control does not provide refund and/or exchanges for any
reason;
Signature

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Hold Harmless Agreement

By signing this, I agree that at the time of adoption the animal above appeared healthy, and that White County Animal Control makes no guarantee about the future health of the animal, and any medical costs related to this animal becomes my responsibility. It is understood that the animal’s known medical status and known temperament have been discussed at the time of adoption. This animal may have been previously exposed to viruses and/or diseases that White County Animal Control would have no reasonable way of identifying. It is my responsibility as this pet’s new owner to assume any additional veterinary costs. By signing below, I assume the risk of adopting this animal and expressly waive any and all claims against White County or its agents, now or in the future for any and all personal or property damage and injury related to this animal.
Signature

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Proper Care Agreement

In compliance with this agreement, I agree to provide my pet with quality care which includes, but is not limited to, healthy food, clean water, adequate space, dry shelter, sanitary conditions, necessary veterinary care, including annual rabies vaccination as required by the Georgia State Law. I will not permit my companion animal to run loose. If my companion animal becomes lost, I will make every reasonable effort to locate and claim the animal. As a responsible pet owner, I will abide by the Ordinances of White County or the County in which I reside pertaining to owning a pet.
Signature

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Spay-Neuter / Vaccine Agreement

I, the undersigned, do hereby agree and understand the following:

If the animal being adopted is not sterilized at the time of adoption, it is the responsibility of the adopter to have the pet spayed/neutered within 45 business days of the adoption date or by the required date set in this agreement. I agree to submit to White County Animal Control, the veterinarian record providing proof that the sterilization has been completed. The veterinarian record must be submitted to White County Animal Control within 10 business days of the sterilization.
Adoption Date

MonthDayYear
Date
Sterilization Requirement Date

MonthDayYear
Date
If the animal being adopted has not received required rabies vaccination at the time of adoption, it is the responsibility of the adopter to have the pet vaccinated within 10 business days of the date of adoption. I agree to submit to White County Animal Control, the veterinarian record providing proof that the rabies vaccination has been completed. The veterinarian record must be submitted to White County Animal Control within 10 business days of the vaccination.
Adoption Date

MonthDayYear
Date
Vaccination Requirement Date

MonthDayYear
Date
Failure to comply with the above statement will result in violations of County and State Law.

OCGA § 4-14-4. Violations
It shall be a misdemeanor to fail or refuse to comply with the requirements of Code Section 4-14-3 and any person convicted of said misdemeanor shall be subject to a fine not to exceed $200.00.
Signature

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Should be Empty:

Applicant Information

I, the undersigned, do hereby agree to the following terms and conditions stated below:

Hold Harmless Agreement

Proper Care Agreement

Spay-Neuter / Vaccine Agreement

I, the undersigned, do hereby agree and understand the following: