PET ADOPTION APPLICATION

Date:

Interested in Adopting a Dog or Cat: (name)

First Name:

Last Name:

Street Address:

City:

State:

Zip Code:

Phone (Cell):

Alternate Phone:

Email:

I reside in a:

House Apartment Mobile Home Duplex Condo

Do you own or rent?

Own Rent

How long at this address:

If rent, Property Owner's name:

If rent, Property Owner's phone number:

Number of Adults in residence:

Number of Children in residence:

Number of Animals in residence:

Who will care for this pet?

Where will the pet be kept? Check all that will apply:

Inside Home Dog house Pen Shed/Barn/Garage Other

Will this pet be left alone? Yes No

If yes, how many hours per day?:

Reason for wanting this pet?

Do you have experience with sick or injured animals? Yes No

Do you have prior experience of caring for a senior animal? Yes No

How many cats or kittens can you deal with at one time?

Have you ever had to turn an animal over to an animal shelter (whether belonging to you or temporarily in your custody? Yes No

If yes explain:

What will happen to this pet when you go on vacation, travel on business or in case of emergency?

Are you familiar with the Animal Control ordinances in your area concerning:

Licensing: Yes No

Shots: Yes No

Leash Laws: Yes No

Would you agree to your home being inspected by a GCHS representative?

Yes No

Veterinarian(s) Name:

Veterinarian(s) Address::

Vet's Phone Number:

I Consent to allow GCHS to Contact Veterinarian

Current Pets in home:

List three references including phone numbers:
#1

#2

#3

I understand and agree that I plan to adopt, provide home, love and care for the animal within the Guadalupe County Humane Society (GCHS) Organization. I understand that pets should not be adopted as a gift to another party outside the home of the listed address of the applying party. As an adopter, I understand that these cat/dogs come from a variety of situations and may not be adapted to home-like environments, where there will need to be training and adapting. I agree that this cat/dog will remain under my care, ownership, and supervision from the date adopted. I will ensure that this animal will have sufficient food, water, care, and essential needs provided daily. I agree that this animal will be treated as part of the family and not chained, lashed or crate bound. Should any problems or issues occur. I will do my best to resolve the issues to the best of my ability for the best interests of the animal. I understand that this animal may entail certain normal risks, such as scratches, bites and or damage to personal property. I hereby waive any and all claims against GCHS, directors, agents, and volunteers under the terms of this agreement. All medical records for vaccines, deworming, flea treatments, injuries, etc will be kept up to date by the GCHS and will be transferred if/when the animal is adopted home. I agree that I will not give away, sell or otherwise move or transfer custody of the cat/dog without reason. If for some reason this animal is not compatible and or passes away due to health reasons and can provide proof, GCHS will provide options for either a new adoptive inquiry or a refund of adoption fee within 14 days of the adopted date.

By signing this, I agree that I understand this information is accurate, and I will abide by our adopting practices and guidelines.

Name of Applicant: