ADOPTION APPLICATION
ADOPTION APPLICATION
Last Name:______________________________ First Name:______________________
Address:_______________________________________________________________
City/State/ Zip Code:_____________________________________________________
Phone:________________________________________
Are you at least 21 years old? ( ) Yes ( ) No
Do you live in : ( ) house ( ) apartment ( ) with parents ( ) mobile home ( ) dormitory
Do You: ( ) Own ( ) Rent if you rent……. Landlord: _________________________
Address________________________
Phone Number ___________________
Please give 2 references: DO NOT INCLUDE ANY RELATIVES OR ANYONE CURRENTLY LIVING WITH YOU.
Two References:
Name: ______________________Address__________________________Phone Number:___________
Name______________________ Address __________________________Phone Number:___________
Do you currently have any other pets? ( ) Yes ( ) NO
Have you ever owned a pet/pets? ( ) Yes ( ) No
I If answered yes, give descriptions: __________________________________________________
Where do your pets live? ( ) Inside ( ) outside ( ) both
Fenced Yard___________ Tie out_________ Walk on Leash __________Let run loose________
Are they spayed or neutered? ___________YES ___________________NO
Your current veterinarian? _______________________________________________________
Why/ What are you considering adopting? ( ) Dog ( ) Cat
( ) Breeding ( ) guard/watch dog ( ) Companion ( ) Hunting
I hereby acknowledge receiving the animal from THE DELAWARE VALLEY HUMANE SOCIETY INC, the below described animal. I agree to care for said animal in a loving manner characteristic of humane society principals and values. I agree to have my pet spayed or neutered within 1 month from adoption date, or at 6 months of age. If the animal is pregnant or becomes pregnant, all puppies/kittens will become property of DVHS. They must be returned when they are weaned and will be offered for adoption. Also pet will be spayed/neutered with a copy of spay/neuter certificate given to DVHS or animal returned. ALL ANIMALS FROM OUR FACILITY HAVE TO BE SPAYED OR NEUTERED.
I affirm by my witnessed signature below that I understand this pet MUST BE SPAYED OR NEUTERED
BY:____________________________________________________________
I acknowledge that my failure to up hold this agreement is grounds for DVHS to repossess the animal. I understand that DVHS investigates all contracts of adoption to affirm the terms of this contract are complied with. (New owner’s names are confidential.) Any application can be denied.
I certify that I am adopting this animal as my own pet and will not give it to another party as a gift, nor will I sell the animal. If the pet adopted does not work out it will be brought back to DVHS for readopting. The said animal will not be used for research of any kind. Also, not to be used for guard duty, breeding purposes or any sort of fighting.
If this adoption is compromised by unforeseen circumstances, the animal in question will be returned to DVHS without charge for care, food or other services. If returned within 14 days of the adoption, the fee will be refunded.
Adopted by:____________________________________________________
Signature: ____________________________________________Date:______________
Address:_______________________________________________________________
City/State/Zipcode:______________________________________________________
Phone Number:__________________________________________________________
Witnessing Shelter Officer________________________________________________
Dog_______Cat______ Other_______ Female _______Male________ Appx. Age________
Breed ____________________Color______________Name_______________________
Wormed with: _____________________________Vaccinations___________________________
Donation: __________________
DVHS ASSUMES NO RESPONSIBILITY FOR THE HEALTH CONDITIONS OF ANIMALS AFTER THEY LEAVE OUR FACILITY. (Rev 05-17-06.TLH)