Fill and Sign the Humane Society Adoption Agreement with Waiver Release Assumption of Risk and Indemnity Agreement Form

HUMANE SOCIETYADOPTION AGREEMENT WITH WAIVER, RELEASE, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT IN ORDER TO ADOPT A PET (ALSO REFERRED TO HEREIN AS “ANIMAL”) FROM ____________ _______________________________________________________ (NAME OF HUMANE SOCIETY) , ADOPTER MUST AGREE TO THE FOLLOWING TERMS AND CONDITIONS OF AN ADOPTION. AT ANYTIME THAT _________________________________________________________________ (NAME OF HUMANE SOCIETY) FINDS THAT THE ADOPTER HAS NOT FOLLOWED THE AGREEMENT, ___________________________________________________________ (NAME OF HUMANE SOCIETY) HAS THE RIGHT TO REMOVE THE PET FROM THE HOME, WITH NO CREDITS OR REFUNDS, AND THE ADOPTER WILL BE SUBJECTED TO OWNER RELEASE FEES AND TERMINATION OF AGREEMENT FINES. ________________________________________________ (NAME OF HUMANE SOCIETY) HISTORY WAIVER ___________________________________________________ (NAME OF HUMANE SOCIETY) DOES OUR BEST TO ENSURE THAT OUR ANIMALS ARE HEALTHY AND READY TO START HIS/HER NEW LIFE IN YOUR HOME. UNFORTUNATELY, THERE ARE MANY DISEASES THAT HAVE VARIOUS INCUBATION PERIODS AND SIGNS OF THE DISEASE MAY NOT BE PRESENT DURING THE TIME OF ADOPTION. ADOPTER UNDERSTANDS THAT BY CHOOSING TO ADOPT THIS PET, HE/SHE ARE TAKING FULL RESPONSIBILITY, AS ITS NEW OWNER, TO CARE FOR ANY UNKNOWN, PRE-EXISTING OR FUTURE ILLNESSES THIS PET MAY HAVE. ____________________________________________________ (NAME OF HUMANE SOCIETY) DOE S NOT GUARANTEE THE HEALTH OF ANY OF OUR ANIMALS. IF YOUR NEWLY ADOPTED PET SHOWS ANY OF THE FOLLOWING SYMPTOMS: SNEEZING, COUGHING, NASAL DISCHARGE, LOSS OF APPETITE, LETHARGY, VOMITING OR DIARRHEA IMMEDIATELY CONTACT OUR VETERINARY PARTNER, _____________________ ____________________________ (NAME) AT ________________________________ (TELEPHONE NUMBER) , WHICH IS LOCATED AT ____________________________________________________ ______________________________________ (STREET ADDRESS, CITY, STATE, ZIP CODE ) . ________ (INITIALS OF ADOPTER) I HAVE RECEIVED A COPY OF MY ANIMAL’S MEDICAL RECORDS WITH _____________________________________________________________ (NAME OF HUMANE SOCIETY) . I ACCEPT FULL RESPONSIBILTY FOR ALL PRE-EXISTING, UNKNOWN OR FUTURE ILLNESSES THAT MAY OCCUR WITH THIS ANIMAL. BY SIGNING BELOW YOU UNDERSTAND AND AGREE TO THE STATEMENT ABOVE REGARDING THIS ANIMAL’S HEALTH: ( DESCRIBE ANIMAL BEING ADOPTED ) __________ ______________________________________________________________________________ ______________________________________________________________________________ ADOPTER’S SIGNATURE ____________________________________________ PLEASE READ AND INITIAL EACH OF THE FOLLOWING STATEMENTS ADOPTER UNDERSTANDS AND AGREES: ________ (INITIALS OF ADOPTER). TO ALWAYS PROVIDE PROPER AND NECESSARY CARE AND TREATMENT FOR THE ANIMAL I HAVE ADOPTED, INCLUDING BUT NOT LIMITED TO HUMANE TREATMENT, SHELTER, FOOD, LOVE, AND VETERINARY CARE; ________ (INITIALS OF ADOPTER) THAT THE ANIMAL WILL NOT BE KEPT CONTINUALLY IN A CAGE, YARD, PEN, HUTCH, OR GARAGE OR ON A TETHER OR BE ALLOWED TO ROAM OFF OF THE OWNER’S PROPERTY; ________ (INITIALS OF ADOPTER) ADOPTER WARRANTS THAT HE/SHE:  IS 18 YEARS OF AGE OR OLDER;  RESIDES IN HIS/HER OWN HOME OR IN A PET FRIENDLY APARTMENT COMPLEX AND HAS PROVIDED PROOF TO THE STAFF OF _______________________________ _______________________________________ (NAME OF HUMANE SOCIETY) ;  IS THE HEAD OF THE HOUSEHOLD;  HAS CONSIDERED HIS/HER LIFESTYLE AND HAS THE TIME, PATIENCE AND IS FINANCIALLY RESPONSIBLE ENOUGH TO CARE FOR THIS ANIMAL FOR THE NEXT 10 YEARS OR MORE;  HAS INFORMED ___________________________________________________ (NAME OF HUMANE SOCIETY) OF ALL MEMBERS OF THE HOUSEHOLD, INCLUDING SMALL CHILDREN AND ANIMALS;  THAT ALL MEMBERS OF THE HOUSEHOLD HAVE AGREED UPON THE SELECTION OF THE PET AND WELCOME THEM INTO HIS/HER HOME. ADOPTER FURTHER UNDERSTANDS AND AGREES: ________ (INITIALS OF ADOPTER) THAT _______________________________________________ (NAME OF HUMANE SOCIETY) HAS THE RIGHT TO INVESTIGATE, UNANNOUNCED, THE LIVING CONDITIONS OF ANY ANIMAL ADOPTED FROM US AND MAY RECLAIM ANY SUCH ANIMAL BEING KEPT IN VIOLATION OF THE ADOPTION AGREEMENT; ________ (INITIALS OF ADOPTER) THAT ADOPTER SHALL ABIDE BY THE STATE LAWS, CITY, AND COUNTY ORDINANCES REGARDING ANIMALS, INCLUDING LICENSING MY PET WITH THE CITY IT WILL BE RESIDING IN THAT THE PET WILL BE PROVIDED WITH A ID TAG WITHIN _____ HOURS OF TAKING THE ANIMAL HOME; ________(INITIALS OF ADOPTER) THAT THE ID WILL BE WORN AT ALL TIMES (ANY ANIMAL STAYING FOR SURGERY MUST HAVE AN ID TAG MADE BEFORE PICKING UP OF THE ANIMAL); ________ (INITIALS OF ADOPTER) THAT THIS ANIMAL IS BEING ADOPTED AS MY OWN COMPANION ANIMAL, AND WILL NOT BE GIVEN AS A GIFT, RESOLD, OR USED AS A GUARD DOG; ________ (INITIALS OF ADOPTER) THAT ADOPTER AGREES TO ENROLL THE ANIMAL IN TRAINING CLASSES TO TRY TO FIX ANY UNWANTED BEHAVIOR OR ACTIVITIES; ________ (INITIALS OF ADOPTER) THAT ______________________________________________ (NAME OF HUMANE SOCIETY) DOES NOT GIVE REFUNDS OR CREDITS FOR THE RETURN OF ANY OF THE ANIMALS ADOPTED FROM IT; ________(INITIALS OF ADOPTER) THAT ANY ANIMAL ENTERING A NEW HOME WILL NEED SOME TIME TO ADJUST TO ITS NEW ENVIRONMENT; SPAY/NEUTER INFORMATION ________ (INITIALS OF ADOPTER) THIS PET HAS ALREADY BEEN ALTERED AND ADOPTER WILL TAKE IT HOME TODAY. SURGERY DATE: _______________________ ________ (INITIALS OF ADOPTER) THIS PET WILL HAVE SURGERY DONE ON THE ABOVE DATE. PLEASE PICK UP YOUR PET FROM ______________________________________________ (NAME OF HUMANE SOCIETY) BETWEEN THE HOURS OF 3:00 PM – 4:00 PM THE DAY OF THE SURGERY. PLEASE BRING PET’S NEW ID TAG AND COLLAR, AND A LEASH OR CARRIER WITH YOU (ANIMALS WILL NOT BE RELEASED TO OWNER WITHOUT THESE ITEMS) PREPAID DATE __________________________ ________ (INITIALS OF ADOPTER) THIS PET IS TOO YOUNG OR IT HAS BEEN RECOMMENDED BY THE DOCTOR TO WAIT TILL THE ABOVE DATE FOR ITS SURGERY. ADOPTER AGREES TO THE PET BACK ON THE DATE ABOVE FOR HIS/HER SURGERY TO BE PERFORMED. BY SIGNING BELOW ADOPTER INDICATEDS THAT HE/SHE UNDERSTANDS AND AGREES TO THE STATEMENTS ABOVE REGARDING THIS ANIMAL’S HEALTH. ADOPTER’S SIGNATURE ____________________________________________ ADOPTION AGREEMENT REGARDING ANIMAL WITH HISTORY OF AGGRESSIVE BEHAVIOR . ________(INITIALS OF ADOPTER) THE UNDERSIGNED ADOPTER HAS BEEN INFORMED OF THE ANIMAL’S AGGRESSIVE HISTORY IN DETAIL AND THAT BY SIGNING BELOW, HE/SHE ARE AGREEING TO HOLD THE ________________________________________________________ (NAME OF HUMANE SOCIETY) , BLAMELESS FOR ANY DAMAGES CAUSED BY AGGRESSIVE BEHAVIOR OF THE ANIMAL HE/SHE ADOPTED. BY SIGNING BELOW YOU UNDERSTAND AND AGREE TO THE STATEMENT ABOVE REGARDING THIS ANIMAL ADOPTER’S SIGNATURE X ____________________________________________ GENERAL WAIVER, RELEASE, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT I UNDERSTAND THAT ADOPTING AN ANIMAL IS NOT WITHOUT RISK TO MYSELF, MEMBERS OF MY FAMILY OR GUESTS IN MY HOME. I HEREBY WAIVE AND RELEASE _______________________________________________________ (NAME OF HUMANE SOCIETY) , HEREINAFTER REFERRED TO AS SOCIETY , ITS EMPLOYEES, OFFICERS, MEMBERS, AND AGENTS FROM ANY LIABILITY OF ANY NATURE FOR INJURY OR DAMAGE WHICH I OR MY FAMILY OR GUESTS MAY INCUR OR RECEIVE AS A RESULT OF ANY ACTIONS OF MY ANIMAL/PET AND I EXPRESSLY ASSUME THE RISK OF SUCH DAMAGE OR INJURY. I HEREBY AGREE TO INDEMNIFY AND HOLD HARMLESS SOCIETY , ITS EMPLOYEES, OFFICERS, MEMBERS AND AGENTS FROM ANY AND ALL CLAIMS OR CLAIMS BY ANY MEMBER OF MY FAMILY OR ANY GUEST IN MY HOME THAT RESULT FROM ANY ACTION OF MY ANIMAL/PET. WITNESS MY SIGNATURE THIS _________________________________ (DATE) _______________________________________ ____________________________________ (Printed Name and Signature of Adopter)