Second Chance Kitty Adoption Application/Contract

Second Chance Kitty

Adoption Application/Contract

Personal Information
Name and description of animal interested in adopting, if known.
Name and description of animal, where seen, i.e., specific store, petfinder, private home etc.
Applicant Name *

First Name Middle Name Last Name Suffix
Co-Applicant Name

First Name Middle Name Last Name Suffix
Applicant(s) must be 21 years of age or older with valid identification. Do you have such required verification? *

Yes No
Has any member or frequenter of your household ever been accused or convicted of animal neglect or abuse? *

Yes No
We are unable to proceed with the application process

Employer Information
Are you employed? *

Yes No
Employer Name *

Work Phone Number *

- Area Code Phone Number
Employer Number *

- Area Code Phone Number
How long with this employer? *
Former Employer *

Are you retired? *

Yes No
Retired Former Employer Name *

If not employed or retired, means of financial support

Pet Information
Is everyone in the household in agreement regarding the adoption of an animal? *

Yes No
Does anyone in the household have known allergies to animals? *

Yes No
Please explain the allergies *
Would this be your first animal? *

Yes No
Do you currently own any pets? *

Yes No

Will your other animals adjust to a new animal in the household? *

Yes No
Were any of the above listed pets not spayed or neutered? *

Yes No
Reason why pet(s) are not altered? *
Have you adopted an animal before? *

Yes No
Name of adoption organization *
i.e., name of shelter or rescue
Approximate date of adoption *

- Month - Day Year
If the adopted animal is not listed above, please indicate the whereabouts of the animal. *
Please give some examples of situations where rehoming a pet is acceptable. *
Have you ever had to give up an animal? *

Yes No
Please explain the circumstances *
In detail, unlimited field
Under what circumstances would you return an adopted animal? *

Starting new job Divorce New Baby Move Pet Illness Your Illness None
Why do you want to adopt this animal? *
Pets often live to be 20+ years. Have you given this considerable thought and are you willing to make this HUGE commitment? *

Yes No
Is someone home during the day? *

Yes No
Approximately how long each day will the animal be alone and what will they have access to? *
Who will be the primary care giver? *
In absence of the primary care giver, who will care for the animal? *
Are you interested in adopting a dog or cat? *

Cat Dog
Have you owned a cat before? *

Yes No
Where was the cat kept?
Is the cat listed on your list of "Animals at Residence"? *

Yes No
Please explain where the cat is now? *
Where are you planning to keep the adopted cat? *
If you are approved to adopt a cat and you encounter behavior problems such as scratching, biting, litter box accidents or deliberate, inappropriate elimination, clawing furniture, destroying property, etc., how will you handle these issues? *
Be specific, give examples of past problems if applicable, what was successful, what wasn't etc.
Have you owned a dog before? *

Yes No
Where did the dog spend most of its time? *
Is the dog listed on your list of "Animals at Residence"? *

Yes No
Where is the dog now? *
If you are approved to adopt a dog and you encounter behavior problems such as chewing furniture or shoes, etc., inappropriate elimination, aggressive behavior, food aggression, etc., how will you handle and correct these issues? *
Do you have a secure fenced yard? *

Yes No
We believe in setting our dogs up for success rather than failure. Dogs with bad behaviors are not good for the dog or the owner. Professional training is very important to us as it gives them the best possible opportunity to thrive. Are you willing to take the dog to professional training at your expense as an adoption requirement? *

Yes No
Who will train, feed and exercise animal? *
Where will the dog be kept at night? *
When you are not with the dog, how will it be kept? *
Select one
Please explain what "other" means. *
Is your home animal-proofed? i.e., no accesible chemicals, poisonous plants, electrical cords covered, etc. *

Yes No
I understand if I am approved to adopt and am unable to continue to care for the animal anymore for any reason, the animal is NOT to be rehomed by myself, or another individual, but must be returned to Second Chance Kitty. *

Yes No

Veterinarian Information
Do you have a Veterinarian? *

Yes No
How will you go about selecting a Veterinarian? *
Veterinarian's name: *

Veterinarian's Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Veterinarian Phone Number for reference verification *

- Area Code Phone Number
Approximate date of last veterinarian visit *

- Month - Day Year
What was this visit for? *
Brief description of services
If your adopted animal requires medical attention for any reason, are you in a financial position to provide such necessary care? *

Yes No

References
Provide three references who are NOT related to, or living with you.
Reference #1 not related or living with you *

First Name Last Name
Phone Number *

- Area Code Phone Number
Reference #2 not related or living with you *

First Name Last Name
Phone Number *

- Area Code Phone Number
Reference #3 not related or living with you *

First Name Last Name
Phone Number *

- Area Code Phone Number

Conditions and Acknowledgements
If requested by Second Chance Kitty, a representative may come to my residence after adoption for a welfare check. *

Yes No
I agree to respond to Second Chance Kitty requests for an adoption update in a reasonable amount of time and provide photos if requested. *

Yes No
I understand if approved for adoption and my adopted pet accidentally is missing for more than 24 hours, Second Chance Kitty shall be notified so they may assist with microchip alerts, lost flyers, notifications to local agencies, such as area veterinarians and animal shelters in an effort to quickly recover the animal. *
Intial
I agree I will NOT sell, trade, gift, abandon, rehome, or surrender to any public or private animal shelter or another party. If I am unable or unwilling to care for the adopted animal I will return ONLY to Second Chance Kitty. Rehoming of adopted animals is NOT permitted. *
Initial
Declawing of Second Chance Kitty cats is prohibited. I agree, I will not declaw the adopted cat. To do so will void this contract and the animal will be confiscated with NO refund and NO reimbursement of any kind. *
Initial
I agree that the adopted animal(s) is (are) being adopted for myself and shall not be gifted, sold, adopted or given to another party. *
Initial
I agree if adopting a cat, it will be kept strictly indoors (exception being short periods in a catio). Second Chance Kitty does NOT adopt indoor/outdoor cats. *
Initial
I agree if adopting a dog, the animal will not be allowed to be outdoors without proper supervision, will not be left alone in a yard for the majority of the day and will NOT be tethered at any time. The dog will be allowed to sleep inside a structure, preferably the home. *
Initial
I agree to care for the animal in a humane manner and be a responsible animal guardian. this includes supplying adequate quality food, clean fresh water, shelter, attention, training, exercise, flea and tick prevention, maintain current vaccinations and medical care. *
Initial
It is understood this application/contract is subject to the approval of Second Chance Kitty and if any information is found to be untrue/deceptive, the review process shall be terminated. If information is found to be untrue/deceptive after the adoption this contract may be voided and the animal returned/confiscated to/by Second Chance Kitty with NO refund. *
Initial
Please attach a copy of your valid identification.
i.e., State Identification, California Driver's License, etc.
Is there anything you would like us to know?
It is understood there will be no refunds, exceptions being, if the animal were to die within seven days of this contract, because of a pre-existing life threatening disease as determined by a veterinarian at the adopter’s expense, a refund may be requested. While every effort is made to evaluate the temperament and health of a Second Chance Kitty rescued animal, no absolute guarantee can be made or should be assumed. *
Initial
Applicant/Adopter Hold Harmless Agreement
I understand that Second Chance Kitty (herein after referred to as SCK) rescues stray, abandoned, abused, neglected and otherwise unwanted animals, almost exclusively cats. Because many of these animals come from unknown origins and backgrounds, SCK makes no claims or representations regarding the health, temperament or disposition of animals. I understand these animals may be unpredictable in their behavior and may bite, scratch or otherwise cause harm whether intentionally or unintentionally. I also understand the status of the health and vaccinations (including rabies) is often unknown initially. In signing this agreement I am verifying that I understand and assume all risks involved to myself, family, friends, and personal pets if participating in a "meet and greet" (meeting the animal to determine compatibility, temperament, etc.), home visit, adopting, or interacting in any way with a SCK animal, included but not limited to; being scratched, injured, frightened or bitten by the animals in connection with the interview or adoption process with SCK. I indemnify, defend and hold SCK, their officers, board members and any other volunteers harmless from any and all claims, lawsuits, injuries, property damages, all actions, causes of actions, claims, demands, losses or rulings, costs, expenses or compensation sustained by any animal or any person in connection (including travel) with my interactions with SCK. I understand and assume the risk, and agree to be legally bound by the terms and conditions stated herein. This waiver includes myself, all of my family members and decedents forever from seeking any legal action against SCK. Applicants/adopters and all family members agree to waive all rights of subrogation and defense against SCK.I have read and understand this notice and agree to hold SCK harmless should any such circumstances arise as mentioned above. It is understood submission of an electronic form, whether containing an electronic signature and/or a typed name, constitutes and holds the same legal binding contractual agreement as a traditional manually signed document. *
Applicant/Adopter Printed Name
Applicant's Signature

Clear
Should your application be approved to adopt a SCK animal, please be advised the animal's microchip is registered currently to the rescue. Please contact us via email at 2chancekittys@gmail.com 30-60 days post adoption to let us know how the animal is doing. Upon knowledge of a favorable adoption, the new owner may request transfer of the animal's microchip to the new owner. Once we transfer the microchip to the new owner, an email will be sent from “Found Animals Microchip Registry” to the new owner indicating SCK has transferred ownership. There is no fee to transfer ownership. SCK registers all microchips with Found Animals, which is also a non-profit organization and offers free lifetime registration. Once transferred, it is imperative your information is maintained and current with the registry, as this is the primary means of your animal finding its way home should they become separated from you.
Initial
Should be Empty:

	Pet Name	Pet Type	Age	Spayed/Neutered Y/N	Vaccines Current Y/N
Pet #1
Pet #2
Pet #3
Pet #4
Pet #5
Pet #6
Pet #7
Pet #8
Pet #9
Pet #10

Second Chance Kitty

Applicant/Adopter Hold Harmless Agreement