Heaven After Hell Rescue Adoption Application

Heaven After Hell Rescue Application/Adoption Contract
Animal's Name
Adoption Fee
Age
Breed
If unsure of a specific animal, tell us what you are looking for:
Adopter Information:
Name of all adults in the home: *
Birthdates of the adults in the home: *
Home Phone Number *

Area Code Phone Number
Cell Phone Number

Area Code Phone Number
Work Phone Number

Area Code Phone Number
Name *

First Name Middle Name Last Name
Email *
example@example.com
Address *

Street Address

Street Address Line 2

City State

Zip Code
Check One: *

House Apartment Trailer Townhome Condo Studio
Are you currently employed? *

Yes No
Place of Employment
If not employed, how do you plan on supporting your pet?

Does anyone in your family have allergies to animals? *

Yes No
Alternate Contact Person *
Alternate Contact Person's Phone Number *
Are all family members in agreement on a new pet? *

Yes No
Why do you want to adopt? *
How many hours per day will the pet you are interested in be outside? *
How many hours per day will this pet be home alone? *
Where will your pet sleep at night? *
Do you have any of the following? (Check all that apply.) *

Suitable Crate Dog Door Frequent Visitors
Do you have a fenced-in backyard? *

Yes No
If you have a fenced-in backyard, what is the height of the fence?
If you have a fenced-in yard, what kind of fence is it?

References

Please list FOUR references that will verify that you are/would be a responsible pet owner (please do not use more than 2 relatives)
Reference #1 *
Reference #1 Phone Number *
Reference #2 *
Reference #2 Phone Number *
Reference #3 *
Reference #3 Phone Number *
Reference #4 *
Reference #4 Phone Number *
Would you allow a representative of HAHR to visit your home? *

Yes No

Adoption Contract PLEASE READ CAREFULLY AS THIS CONTRACT IS BINDING

(Please Initial Where Required)
I understand that Heaven After Hell Rescue (HAHR) makes no representation, warranty, or guarantee as to the health, disposition, breed, or ultimate size of this animal because HAHR may be uncertain as to its background. I understand that the animal has displayed no evidence of illness or behavior issues except as disclosed in the pets medical records.
Initials *
The adopter may not sell, give away, or surrender the adopted animal to any person, rescue, shelter, or pound without the express written permission of HAHR. If the adopter does sell, give away, or surrender the adopted animal without permission, they will be liable for any expenses related to the reacquisition of the animal in relation to travel expenses, fees, legal expenses, or any other expenses incurred by HAHR in regaining custody of the animal. In addition, a $250 penalty will be surrendered to by the adopter in the event HAHR acquires knowledge that the adopter has sold, given away, surrendered, or placed the pet in the city or county pound.
Initials *
I agree that HAHR may remove an animal from my care in the event that neglect takes place. This may include but is not limited to: failure to follow any of the listed agreements in this contract, intent to give away, sell, or surrender the adopted animal, failure to provide adequate vet care, failure to provide adequate daily care of the animal. (Please initial below.)
Initials *
I agree that my new pet will be vaccinated yearly, treated by a professional veterinarian as necessary, including emergency medical treatment, and groomed regularly if the breed requires. (Please initial below.)
Initials *
I agree that no claim, action, demand, suit in law or equity will be brought by me against HAHR, its agents, or officers because of this adoption and I hereby release HAHR, its officers, veterinarians, or agents from all actions, suits, claims, and demands arising from this adoption agreement. (Please initial below.)
Initials *
I agree that I am responsible for any and all medical care once I take possession of my new pet. (Please initial below.)
Initials *
I agree that the adoption fee will not be refunded after 7 days. (Please initial below.)
Initials *
I agree to provide food, shelter, water, veterinary care and loving, humane treatment at all times. (Please initial below.)
Initials *
I agree not to have the adopted pet altered in the form of tail or ear docking, declawing, or any other body modification without the express written permission of HAHR. (Please initial below.)
Initials *
While adult dogs require one booster vaccination per year to protect against serious illness and disease, puppies require a series of vaccinations (4 vaccinations at 2-4 week intervals). To ensure that each puppy is well protected against serious illness and disease, by signing this adoption agreement, you agree to get the required series of vaccinations at the specified intervals by a licensed veterinarian. You shall be financially responsible for all vaccinations and any other necessary medical care after adoption. (Please initial below.)
Initials *
By signing this application, it is agreed that all statements made are truthful. This application must be approved by a HAHR adoption representative, and such representative reserves the right to refuse adoption at their discretion now or at the time of a home visit. (Please type your name below. By typing your name below you are signing this contract virtually.)
Initials *
Please type today's date *

Month Day Year
Date
Should be Empty:

Heaven After Hell Rescue Application/Adoption Contract

Adoption Contract PLEASE READ CAREFULLY AS THIS CONTRACT IS BINDING