Adoption Application

Date

MonthDayYear

Name

First NameLast Name

Phone Number

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

E-mail

Name of Animal

About your home

ApartmentHouse

Do you

OwnRent

If you rent, please list name and contact number for landlord

Do you have a fenced yard?

YesNo

Pet will be kept

IndoorsOutdoorsBoth

How many adults live in household?

How many children and their ages

Who will be financially responsible for animal?

Does anyone in your household have allergies/asthma?

Reasons for wanting to adopt:

Number/type of other pets in household

Are all pets spayed/neutered?

YesNoSome

Are all pets up to date on vaccinations?

YesNoSome

Name and phone number of veterinarian

Please select any of the following that apply:

I have previously surrendered a pet to an animal control facilityI have had to reclaim a pet from an animal control facilityI am aware that pets must be vaccinated yearly for rabies per GA lawI am aware that the county has a leash law that requires pets to be contained at all timesI have plans for the animal should I be required to relocateI am willing to allow an animal control officer access to premises where animal will be keptI have had an animal in my possession die from parvo/distemper/other contagious disease in the past 90 days

Sick Animal Policy

The animals at the Effingham County Animal Control Shelter have not been examined by a veterinarian and there is a possibility that they have an illness or have been exposed to an illness that has not been detected before adoption. You as the adopter of such animal(s) have the right to return the animal within ten (10) days with a statement from a veterinarian that the animal is sick in order to receive a refund.

The shelter is not responsible for and will not pay any medical bills associated with the adoption, care, custody, or provisions or the sick animal policy of the adopted animal or bills arising from the adopted animal. There are NO exceptions to this policy.

Animal Temperament Policy

The animals in the Effingham County Animal Control Shelter have been handled daily by the shelter personnel. Shelter staff can only tell of behavior they have observed about the animal during the time that the animal has been at the shelter. Shelter staff cannot know how the animal will act in a new environment or another situation.

The Effingham County Animal Control Shelter cannot guarantee the temperament of this animal(s) and is therefore not responsible for any liability from actions or health of the adopted pet.

Additional fees could be incurred when pet is altered (ie. if female dog is in heat/pregnant). These must be discussed with veterinarian. Shelter is only responsible for basic spay/neuter.