Animal Adoption Agreement

Name: ________________________________________________________

Address: ____________________________ Telephone: ________________

City, State, Zip: ________________________________________________

Email Address: _________________________________________________

Drivers’ License Number: _________________________________________

Children: Yes or No, if yes, what are their ages? ______________________

Do you own or rent? ________________________

If you rent, landlord’s signature: ____________________________________

(If animal is not spayed/neutered at the time of adoption) I agree that I will have the animal spayed/neutered at the appropriate time.  _________ (initial)

• I agree that the animal is being adopted for myself and will not be sold, adopted, or given to another party.  ___________ (initial)
• (If adopting a dog) I agree that this dog is to be a companion animal, not a guard dog.  The dog will live inside my home, not outdoors.  ________(initial)
• I agree to care for the animal in a humane manner and be a responsible animal guardian.  This includes supplying adequate food, water, shelter, attention and medical care.  _________ (initial)
• I agree that if at any point that I can not keep the animal, I will return him/her to TSHS.  _______  (initial)
• I understand and agree that the current guardian makes no guarantees about the animal’s temperament and is not responsible for future damages or injuries caused by the animal.  ________ (initial)
• I agree to keep the animal’s former guardian (TSHS) informed of my current home address and phone number.  ________ (initial)
• I agree that the animal will not be allowed outdoors without proper supervision.  When taking my cat/dog outdoors, they will be on a secure harness and wear proper ID.  _______ (initial)

Please list two references.  If you currently own an animal(s), one reference must be your current veterinarian.

Name:  _________________________________________________________

Address:  _________________________ Telephone:  __________________

City, State, Zip:  _________________________________________________

Name:  ___________________________________________________________

Address:  _________________________ Telephone:  ____________________

City, State, Zip:  ___________________________________________________

Vet Office Name:  ___________________________________________________

Address:  ___________________________ Telephone:  ____________________

City, State, Zip:  ______________________________________________________

I agree that all statements I have made on this form are true.  If it is found that any statements I have made on this form are not true the adopted animal can be confiscated.

Adopter’s Signature: ___________________________ Date: _______________