PC's PETS ADOPTION AGREEMENT
ADOPTER'S INFORMATION:
Name:
Address:
City:
State:
Zip Code:
Phone Number:
References Checked: Y/N
Homecheck Completed: Y/N ________ (initial)
INFORMATION ABOUT ADOPTED ANIMAL:
Cat/Dog/Other
If other, specify:
M/F
Date of Birth:
Color:
Other description:
ADOPTER'S AGREEMENT
- I agree that the animal is being adopted for myself and will not be sold, adopted, or given to another party. _________ (initial)
- I agree that the animal will not be allowed outdoors without proper supervision. When taking my dog outdoors, they will be on a secure harness and wear proper ID. _________ (initial)
- I agree that this dog is to be a companion animal, not a guard dog. The dog will live inside my home, not outdoors. _________ (initial)
- I agree to care for the animal in a humane manner and be a responsible animal guardian. This includes supplying adequate food, water, shelter, attention, and medical care. _________ (initial)
- I agree that if at any point I can not keep the animal, I will return him/her to the original rescue without requesting a fee. _________ (initial)
- I understand and agree that the current rescue makes no guarantees about the animal's temperament and is not responsible for future damages or injuries caused by the animal. _________ (initial)
- I give the current rescue permission to call my home at any reasonable time to assure that the animal is being properly treated and cared for. _________ (initial)
- I agree to keep the rescue informed of my current home address and phone number. _________ (initial)
I agree that all statements I have made on this form are true. If it is found that any statements I have made on this form are not true the adopted animal can be confiscated with or without law enforcement authority.
Name:
Address:
City:
State:
Zip Code:
Phone Number:
Driver's License Number:
License Plate:
Adopter's Signature:
Date:
Signature of Rescue Coordinator:
Date: