Pet Adoption Application Form

Puffin's Place

Adoption Application, Contract and Waiver

Prospective Pet Parent*

First NameLast Name

Name of Pet You Wish to Adopt*

Email Address*

Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Do you own any pets?*

Please provide your veterinarian's name and phone number:

Do you own or rent your home?*

OwnRent

What is your landlord's pet policy?*

If you rent, please provide your landlord's name and contact number here:*

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

YesNo

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 or unruly behaviors in your pet?*

Please provide the names 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?*

YesNo

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*