Pet Adoption Application Form

Adoption Application, Contract, and Waiver

Perspective Pet Parent *

First Name Last Name

Name of Pet You Wish to Adopt *

Email Address *

Phone Number *

Area Code Phone Number

Address *

Do you own any pets? *

Pet Name(s)

Pet Breed(s)

Pet's disposition and behavior towards other pets?

What is your experience with this type of animal, if any?

Do you have a safe, escape-proof habitat for this animal, or will you prior to potentially bringing the animal home?

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? *

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) *

If you answered "Yes" to the above question, please describe experience with animals:

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

How would you deal with behavioral issues in your pet? *

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 understand there is an adoption donation associated with adoption of a pet from Critter Conscious. and that it is tax deductible according to IRS 501(c)3 guidelines. I understand this donation will ensure the organization is equipped to rescue another homeless pet.
By clicking the submit button, I understand there is no "cooling off" period, and that if I no longer want or can no longer care for my adopted pet, I agree to notify Critter Conscious BY EMAIL and provide a 14 day period to allow Critter Conscious to make arrangents for my pet to be taken back into rescue.
By clicking the submit button, I agree to indemnify and hold harmless Critter Conscious 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 understand that Critter Conscious will disclose any of the pet's health or behavior issues known by the above named rescue group before adoption is completed.
By clicking the submit button, I understand that if I no longer want my pet, or am no longer able to care for my adopted pet, I will be directed to surrender my pet to Critter Conscious and provide transport to where Critter Conscious deems appropriate.
By clicking the submit button, I verify all of the above information is true and accurate.

Signature of Potential Pet Parent *