This sectin fr C.A.R.E. Use Only Puppy Dg Kitten Cat Pet s Name: Estimated DOB (r age): Breed: Clr: Micrchip #: Male Male/Neutered Female Female/Spayed Adptin Fee: $ Ntes: Cntact Infrmatin First Name: Last Name: Date: Street Address: City, ST ZIP Cde: Hme Phne: Other Phne: Cell: Wrk: E- Mail Address: Living Situatin - Please tell us what yur hme life will be like fr yur new pet. Wh will be the wner f the pet? Yu Family Member Other Will the pet be living with children? Yes N If yes, what are their ages? Des anyne in the hme have pet related allergies? Yes N Will the pet be alne while the wner is at wrk? Yes N Hw will the pet get exercise and play time? Will this be the nly animal in the hme? Yes N If n, what ther animals will the pet be living with? D yu Rent Own? If yu rent, have yu cnfirmed that yur landlrd r cmmunity assciatin will allw pets f this breed, size, etc? Yes N Please prvide yur landlrd s name and telephne. Name: Telephne As a precautin, please prvide the name and telephne number f an individual wh wuld assume respnsibility fr yur pet, in the event that smething unfreseen were t happen and yu were unable t cntinue caring fr the pet. Name: Relatinship: Hme Phne: Cell Phne: 1 f 5
A Just- In- Case Planning Guide fr yur pet s frever care is available; wuld yu like a cpy? Yes N Pet Ownership Histry - Please tell us abut the past pets in yur life. Have yu wned ther cats r dgs in the past 10 years? Yes N Wh is yur current vet? Veterinary checks are a required part f the pet adptin prcess. I understand this and I give my permissin fr (yur vet) t release any medical infrmatin requested by C.A.R.E regarding my current and past dgs r cats. Signature: Date: Terms & Cnditins f Adptin Please read, and initial in the bx next t each statement. I will prvide prper and adequate fd, water, husing, exercise, grming and humane treatment at all times. I will have this animal seen by a licensed Veterinarian f my chice, at my expense, within ne (1) week frm the date f this cntract. Thereafter, I will have the animal examined at least nce a year by a Vet, immunized as recmmended, administer heartwrm preventive (dgs nly) and flea treatment (dgs and cats) as apprpriate, at my expense. I will seek apprpriate Vet care and/r treatment fr this pet if s/he shuld becme sick r injured. I agree t bey lcal licensing and animal enfrcement laws. I will nt permit the animal t run at large r t becme a public nuisance, and will always keep means f identificatin n him/her at all time. If s/he gets lse and is picked up by a public r private facility, I will immediately retrieve this animal, when ntified. This animal will never be staked ut r chained. I have been tld f the animal s histry and traits. I understand C.A.R.E. may nt have much r any infrmatin given the animals rigins. I agree t keep this animal as a pet and cmpanin animal nly. I will nt use, sell r dnate my pet fr research, fighting r breeding purpses. This animal will nt be transprted in an pen pickup truck r car. I intend t care fr this animal fr the rest f his/her life, and if fr any reasn I am unable t d s, I will cntact C.A.R.E. fr assistance r find anther suitable, lving hme fr this animal and let C.A.R.E. knw. I understand C.A.R.E. may nt be able t take the animal due t space. 2 f 5
Acknwledgements Please read, and initial in the bx next t each statement. I accept the animal as it is at the time f adptin and understand that C.A.R.E. is nt respnsible fr any medical cnditin nt readily detected r detectable prir t r at the time f this adptin r discvered after such adptin. I have been infrmed that all animals can, frm time- t- time, carry and transmit diseases (e.g., ringwrm) and that these diseases may be undetectable in what appears t be a healthy animal at adptin time. I am aware that pets may exhibit nrmal but ptentially undesirable behavirs including, but nt limited t, aggressin; huse siling; biting; scratching (peple, furniture and wdwrk); barking; digging; urine marking (dgs); urine spraying (cats); and that these behavir patterns may be difficult t manage. N ne at C.A.R.E. has tld me that this pet will nt engage in any f these behavir patterns. I am aware that it usually csts between $250 and $750 per year t feed, huse, train and prvide vet care fr a pet. I am financially able t meet these expenses fr my adpted pet. I understand that an animal can be unpredictable and that C.A.R.E. cannt anticipate r insure against unexpected cnduct f an animal adpted frm C.A.R.E. I acknwledge that C.A.R.E. has nt made, thrugh its staff r vlunteers, any warranties regarding the future cnditin, temperament r cnduct f this animal. I hereby accept this animal as is, assume all risks and respnsibilities assciated with wnership f this animal, including bites. I hereby fully and cmpletely release, indemnify and hld harmless C.A.R.E., it s directrs, vlunteers and agents frm any claim, cause f actin r liability f any srt r nature, whether knwn r unknwn, directly arising ut f, r in cnnectin with, the adptin, care r wnership, maintenance, retentin, temperament, cnduct r cnditin f the animal. Taking int cnsideratin the life span f a healthy animal, I will make necessary arrangements t have my pet cared fr in the event that I am nt able t d s myself (e.g., mental and/r physical decline r death). Because C.A.R.E. is a nn- prfit and the cst invested in each animal s adptin cannt be recvered, there are n refunds f adptin fees. Mnthly Medicatins (Cats) Please read and sign each statement as necessary. Cats require flea preventin. I understand that the cat I am adpting is currently n flea preventin. I als understand preventin is given n a mnthly basis and that it is my respnsibility t purchase and administer the preventative medicatin. Signature: Date: I als understand that my new cat may require additinal vaccines at my expense. Signature: Date: 3 f 5
Mnthly Medicatins (Dgs) Please read and sign each statement as necessary. Dgs require Heartwrm and flea preventin. I understand that the dg I am adpting is currently n heartwrm and flea preventin. I als understand that bth medicatins are given n a mnthly basis and that it is my respnsibility t purchase and administer the preventative medicatin. Signature: Date: I als understand that my new dg may require additinal vaccines at my expense. Signature: Date: Apprvals T the best f my knwledge, the infrmatin prvided abve is accurate. I understand that a hme visit by a C.A.R.E. Representative may be required befre apprval f my applicatin. I have a general understanding f C.A.R.E. s adptin requirements and agree t abide by them. I agree t allw a C.A.R.E. Representative t cntact me at any time r times requesting specific infrmatin regarding the animal s well- being and medical care, t see the premises where the animal is kept, and t reclaim the animal if it is determined that the animal is nt receiving adequate care. In the event C.A.R.E. reclaims the animal, I knwingly and freely hld C.A.R.E. harmless frm any and all liability, damages, debts, csts and expenses incurred during my pssessin f the animal. I als understand that nce this adptin is finalized and I take pssessin f the pet, there are abslutely, n refunds f adptin fees. Signature f Adpter: Date: Apprved by C.A.R.E.: Date: Help Make a Difference - Becme a C.A.R.E. Member TODAY! Wuld yu like t becme a C.A.R.E. Member TODAY? Yes N If yu selected yes, a C.A.R.E. Vlunteer will prvide yu with a membership frm t cmplete. 4 f 5
Infrmatin t Cnsider Upn Cmpletin f the Adptin Applicatin C.A.R.E. s plicies are such that: Cmpletin f this applicatin des nt guarantee that yu will be apprved t adpt the animal. A psitive vet reference is required fr any animal t be released t a frever hme. It is pssible that ther applicatins are pending n any given animal. It is ur duty t place the animal in the hme that will best benefit a lng life f happiness fr the animal. Due t varying circumstances, the animal in which this applicatin has been cmpleted fr, may nt be able t g hme with yu tday. Reasns culd be: Occasinally, it is nt pssible t cnfirm veterinary references n the spt because the veterinarian in questin may nt be reached at that specific time. All animals need t be evaluated by ur veterinarian befre ging t a frever hme. We d nt have a veterinarian n staff, s smetimes this takes time. All adptins must be apprved by ur Animal Care Manager (ACM). Varius days thrughut each mnth, the ACM is cmmitted t assist during animal surgeries at ur shelter and is unable t cmplete veterinary reference checks r apprve adptins. I have read and understand the abve C.A.R.E. plicies: Date: *Office Vlunteers, upn cmpletin f this applicatin, please phtcpy this page fr the applicant t keep. 5 f 5