Pet Adoption Application

Pet Adoption Application

This Pet Adoption Application (the "Application") is submitted by the undersigned applicant to evaluate suitability for adoption of an animal under the care or custody of the adopting organization. Submission of this Application does not guarantee placement; the organization reserves the right to accept or deny any application in its sole discretion.

Applicant Information

Residence and Household

Residence Type: Own Rent Other

If renting, Landlord Name:   Phone:

Pet(s) Requested

Species:   Breed / Approx Age:

Current and Past Pet Ownership

Veterinary and Reference Information

Primary Veterinarian/Clinic:

Clinic Phone:   City:

Adoption Terms and Payment

Adoption Fee Amount:   Payment Method:

Payment Terms: Applicant agrees to pay the adoption fee in full at time of adoption unless alternate arrangements are expressly approved in writing by the organization. Failure to remit agreed fee within the approved schedule constitutes breach and may void the adoption.

Late Fee: If a payment plan is approved, a late fee of will apply for each 30-day period past scheduled payment, to the extent permitted by law.

Care, Health and Return Policy

Spay/Neuter and Medical Care: Applicant agrees to have the adopted animal spayed or neutered and to provide routine and emergency veterinary care as recommended by a licensed veterinarian. If the animal is not already altered, applicant agrees to complete alteration within the timeframe specified by the organization or reimburse the organization for costs incurred.

Return Policy: If for any reason the applicant cannot keep the animal, the applicant agrees to notify the organization and return the animal to the organization. The organization reserves latitude to accept returned animals and may assess a rehoming fee where appropriate. Adoption fees are generally non-refundable unless otherwise stated in writing by the organization.

Consent, Authorization and Release

I certify that the information provided in this Application is true and complete to the best of my knowledge. I authorize the organization to contact my veterinarian, landlord, and references to verify information provided. I understand that falsification of information is grounds for denial of this Application or immediate rescission of adoption.

I release and hold harmless the organization, its officers, agents, and representatives from any liability arising from my adoption and caretaking of the animal, except for willful misconduct or gross negligence by the organization. I agree to indemnify the organization for claims arising from my failure to comply with the terms of this Application and any adoption contract executed at the time of placement.

I consent to a scheduled home visit by organization personnel prior to or within 14 days following adoption.

Governing Law and Entire Agreement

Governing Law: This Application and any resulting adoption contract shall be governed by and construed in accordance with the laws of the state in which the organization is located, without regard to conflict of law provisions.

Entire Agreement: This Application, together with any adoption contract executed at the time of placement, constitutes the entire agreement between the parties with respect to adoption of the animal and supersedes all prior representations, negotiations and agreements, whether written or oral.

Acknowledgment and Certification

By signing below I certify under penalty of perjury that the foregoing information is true and correct. I understand that completing this Application does not transfer ownership of any animal and that adoption is consummated only upon execution of a separate adoption agreement and acceptance by the organization.

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