Cat Adoption form

First Name *

Last Name *

Street Address *

City *

State *

Cell Phone *

Home Phone *

Email address *

Emergency Contact Number *

Are you a Veteran?

Yes No Choose not to answer

Name of animal you are applying for

Number of children in the home or that visit and ages *

Please list animals in the household (list name, breed, age) *

Do you rent or own?

Please Provide Landlord name and phone number

Are your current pets... *

Up to date on vaccinations Spayed or neutered On flea and heartworm treatment Kept inside N/A No Current Pets

Name of vet address and phone: *

Do we have your permission to do a vet check? *

Yes No N/A Never had any pets

If you have a dog, have they been around cats before? *

Yes No N/A no Dogs

When left alone, where will your new cat stay? *

Is your current cat declawed? *

Yes No N/A no current cats

Are you planning to declaw this cat? *

Yes No

List 2 References (names and phone #) *

RELEASE STATEMENT Adopter(s) of the dog/cat identified in the Preamble of this Agreement, agree, understand and promises to forever release, discharge, indemnify and hold harmless Pound Pets, Inc., or any of its agents or representatives, board members, or any other person associated with this group, their heirs, administrators, executors, successors and assigns from any and all claims, damages, costs, expenses, loss of services, actions and causes of action arising out of bodily injuries, mental anguish or property damage or any other occurrence from the present time on, caused by the adoption of this dog/cat. This includes any and all loss, damage, fees and expenses (including legal or medical fees) by reason of liability imposed by law upon Pound Pets, Inc. or any of it's agents or representatives, heirs, administrators, executors, successors and assigns because of bodily injuries or death to any person(s), or animal, including the adoptive owners, or any damage to property arising out of or in consequence of the placement of this dog/cat, howsoever such injuries, death or damage to property may be caused, whether or not the same may have been caused by, or may be alleged to have been caused by, negligence of the aforementioned parties or any of their agents or representatives, or any other person connected with Pound Pets, Inc. Adopter(s), the undersigned, assumes sole responsibility for all manner of actions and causes of actions, suits, debts, accounts, bonds, covenants, contracts, agreements, judgments, claims and demands whatsoever arising out of possession and/or the placement of this animal. Adopter also understands that this organization will not be responsible for any medical care or costs thereof required for this animal from this day forth. All expenses resulting in any injury or illness and all care will be adopter’s sole responsibility. In addition, adopter hereby agree that Pound Pets, Inc., its agents or representatives, board members or any other person associated with this group, their heirs and assigns, successors and executors, will not and cannot be held responsible for the conduct, behavior, health or disposition of this animal. Adopter shall assume all responsibility for damages, suits, debts and actions that arise from ownership of this animal. Adopter(s) realizes that adopter(s) hereby give up any right to take any legal action whatsoever against Pound Pets, Inc., it's agent or representatives, board members, heirs, administrators, executors, successors and assigns. Unconfirmed and unverifiable information has been voluntarily provided to this group by its former owner, if known, but Pound Pets, Inc., has undertaken no investigation with regard to the history or physical condition of the animal other than given by the previous owner (if known). Pound Pets, Inc. and any other agents or representatives, board members, executors, successors, agents and assigns, make neither warranty nor guarantee, expressed or implied, as to the physical, medical, mental or behavioral condition of this animal, its background or its suitability or compatibility. Adopter(s) therefore hereby releases Pound Pets, Inc., and all of its heirs, administrators, executors, successors and assigns, board members, and any other agents or representatives from any and all responsibility with regard to this adoption, which adopter(s) undertake voluntarily and with full knowledge of the above release and its implications. I certify that I have read and understand the terms of this Pet Adoption Agreement and Release Statement by signing below on

Day *

Month *

Year *

If, for any reason or at any time, I am unable to care for my adopted pet, I agree to return my adopted pet to Pound Puppy Volunteers or allow them time to find an appropriate foster home; I further agree never to abandon my adopted pet or deposit my adopted pet at an animal shelter or research facility; however, before returning my adopted pet to Pound Puppy Volunteers, I agree to exhaust all options available to me including, but not limited to, obedience training, a behaviorist, crate training or veterinary advice to solve any physical or behavioral problem that may occur with my adopted pet or between me and my adopted pet.

I certify that all the above information provided above is complete and correct to the best of my knowledge. I am aware that failing to answer all questions can result in my application being dismissed or slowed for approval. I am also aware that my application is subject to approval and may not be approved for this adoption.Click to edit this text...

I have read the release statement. I have no questions and agree to the terms. *

I agree I dont' agree

Typing your name below will serve as a legal signature. By signing below, I am attesting to the truthfulness of my answers.

Signature

CAT ADOPTION FORM