Pet Adoption Application Form

Adoption Application, Contract and Waiver

Perspective Pet Parent*

First NameLast Name

Name of Pet You Wish to Adopt*

Email Address*

Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Do you own any pets?*

Pet Name(s)

Pet Breed(s)

Pet's disposition and behavior towards other dogs?

Please provide your veterinarian's name and phone number:

Do you own or rent your home?*

OwnRent

Do you have a yard?*

YesNo

If "Yes" to the above, is it fenced? please describe

What is your landlord's pet policy?*

If you rent, please provide your landlord's information here:*

Have you ever surrendered a pet you own to any animal shelter including a "low" or "no kill" shelter?*

YesNo

Are there children in the home? (If yes, please list ages)*

If you answered "Yes" to the above question, please provide detail:

How many hours per day would the pet be alone?*

Will you crate your pet?*

If you have to leave town, emergently or planned, where would your pet stay?*

How would you deal with behavioral issues such as barking, chewing, destructive behavior, bathroom accidents indoors, unruly leash behaviors in your pet?*

Please provide the names, emails, and contact numbers for 3 personal references:*

Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment?*

YesNo

If you answered "Yes" please provide a detailed description:

By clicking the submit button, I understand Old Drum and Friends might check my references including veterinary and personal.
By clicking the submit button, I understand there is no "cooling off" period, and that if I no longer want or can no longer care for my adopted pet, I agree to notify Old Drum and Friends Animal Shelter BY EMAIL and provide a 14 day period to allow Old Drum and Friends Animal Shelter to make arrangents for my pet to be taken back.
By clicking the submit button, I understand that if I no longer want my pet, or am no longer able to care for my adopted pet, I will be directed to surrender my pet to Old Drum and Friends Animal Shelter and provide transport.
By clicking the submit button, I verify all of the above information is true and accurate.
However, I understand that the shelter makes no warranties regarding the health of this animal. I agree to take the animal to a veterinarian for evaluation promptly.
I accept the animal as is, and I assume all risks of ownership of the animal. I release Old Drum & Friends Animal Shelter from all liability for any damage or injury which the animal may cause to any person or property.
I understand and agree that some or all of the information provided on this form regarding that animal may have been received by Old Drum & Friends Animal Shelter from third persons and Old Drum & Friends Animal Shelter does not warrant the accuracy of such information.
I understand that pets are a lifetime commitment and that even though my life, location, job, housing etc. may change, it is my intention to make my pet a part of that change.
I understand that, typically, the animals available for adoption from the shelter lack a complete history, and the shelter cannot guarantee health or personality of any animal adopted from the facility.
I understand that all advice given by Old Drum & Friends Animal Shelter staff regarding animal care/behavior is based on professional experience, and that I should follow up with my veterinarian or a professional dog trainer regarding health and behavior problems I may experience in my home.
I understand that the shelter intends to place each animal in the appropriate home, and therefore, reserves the right to refuse adoption to me at any time during the process for any reason.

I certify that I am at least 18 years old of age and the information I have given is true. I recognize that any misrepresentations of facts may result in my losing the privilege of adopting a pet. I authorize any and all verified statements made in the application, and I understand that Old Drum & Friends Animal Shelter has the right to deny my application at any time during the adoption process.
I am fully aware that I am adopting a living creature, and as such, there will likely be a period of time that this animal needs to adjust to my home. I also understand that Old Drum & Friends Animal Shelter is unable to
guarantee the health of animal. If this animal becomes ill, I certify that I am financially and/or emotionally preparedto treat this animal at my own expense.

Signature of Potential Pet Parent*