Pet Adoption Application Form

Puffin's Place

Adoption Application, Contract and Waiver

Prospective Pet Parent *

First Name Last Name

Name of Pet You Wish to Adopt *

Email Address *

Phone Number *

Area Code Phone Number

Address *

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

Do you own any pets? *

Please provide your veterinarian's name and phone number:

Do you own or rent your home? *

Own Rent

What is your landlord's pet policy? *

If you rent, please provide your landlord's information here: *

Have you ever surrendered a pet you own to any animal shelter including a "low" or "no kill" shelter? *

Yes No

Are there children in the home? (If yes, please list ages) *

How many hours per day would the pet be alone? *

If you are adopting a cat do you plan on declawing *

If you have to leave town, emergency or planned, where would your pet stay? *

How would you deal with behavioral issues such as barking, chewing, destructive behavior, bathroom accidents indoors, and unruly behaviors in your pet? *

Please provide the names, emails, and contact numbers for 2 personal references: *

Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment? *

Yes No

If you answered "Yes" please provide a detailed description:

By clicking the submit button, I agree to Puffin's Place adoption process. I will undergo a homecheck, and interview at the discretion of Puffin's Place board members.
By clicking the submit button, I understand Puffin's Place will check my references including veterinary and personal.
By clicking the submit button, I understand there is an adoption donation associated with adoption of a pet from Puffin's Place I understand this donation will ensure the organization is equipped to rescue another homeless pet.
By clicking the submit button, I understand that if I no longer want or can no longer care for my adopted pet, I agree to notify Puffin's Place BY EMAIL and provide a 14 day period to allow Puffin's Place to make arrangents for my pet to be taken back into rescue.
By clicking the submit button, I agree to indemnify and hold harmless Puffin's Place against any losses, lawsuits, claims, injury, damages incurred by me or to any persons or property by my adopted pet, once adoption has been completed.
By clicking the submit button, I verify all of the above information is true and accurate.

Signature of Potential Pet Parent *