Application to Adopt From In Our Hands Rescue

Thank you for coming to adopt a pet! The decision to adopt a pet is an important one which we take very seriously. Please take a moment to read and carefully complete this application. In order to adopt a pet, you must be: at least 18 years old • be able to provide references and two forms of identification • consent to a home visit • pay the adoption fee (listed below) • IOHR reserves the right to deny any application. Thank you for your patience and cooperation.

Your Contact Information

First Name

Last Name

Your Age

Street Address

Address Line 2

City

State

Zip Code

Cell Phone Number

Other Phone Number

Email Address

More About You

Why do you want to adopt an animal?

Which kind of animal are you applying to adopt? this is the Minimal suggested donation for this pet

Were will the animal primarily be kept?

Outdoor

Indoor - free roaming or confined to specific space

Indoor - crated

List below any pets you have owned in the last 5 years, how long you had the pet and whether or not you still have the pet. If not, where is it?

Are your current pets spayed, neutered and vaccinated? If not, why not?

Please provide the name, address and phone number of your veterinarian here. Under whose name are the vet records?

Do you own or rent your home?

own

rent

Are you allowed to have pets?

yes

no

List all people living in the home and their ages.

Do you or anyone in the household have pet allergies?

yes

no

Please let us know how many hours the pet will be left alone each day and when alone, where will he or she be kept?

Please list your occupation, the name of your employer, address, name of your supervisor and phone number below:

Do you have a yard?

yes

no

If so, is it fenced in?

yes

no

If yes, how high?

Do you have screens in your windows?

yes

no

Have you ever had to give up a pet? If so, please tell us why and where the pet went.

Do you have an area to quarantine the pet from other animals if necessary?

Do you feel capable of handling and helping to mitigate behavioral problems like "marking in the house," separation anxiety or fearfulness with or without a veterinarian or behaviorist's assistance?

yes

no

Can you describe any obedience training experience, or past personal experience with behavioral or medical issues?

Please provide IOHR with three personal references with telephone numbers. Only one of the three may be a family member.

Are you willing to work through unexpected hardships with your pet, ie, housetraining, separation anxiety, fear, socialization, acclimation to other pets, etc?

yes

no

Adoption Contract and Affirmation

Do you agree that the animal is being adopted for yourself and will not be sold, adopted or given to another party?

yes

no

Do you agree that the animal will not be allowed outdoors without proper supervision? When taking the animal outdoors, do you agree that he or she will be on secure harness and wear proper ID?

Yes

No

If adopting a cat, do you agree that you will NOT declaw the cat or allow the cat outdoors?

Yes

No

If adopting a dog, do you agree that this dog is to be a companion animal and not a guard dog? Do you agree that the animal will live inside your home, and not outdoors or in a business location?

Yes

No

Do you agree to care for the animal in a humane manner and to be a responsible animal guardian? This includes supplying adequate food, water, shelter, attention and medical care.

Yes

No

I agree that if at any point I cannot keep the animal, I will return him/her to In Our Hands Rescue, I understand donations are non refundable

I agree

I disagree

I understand and agree that In Our Hands Rescue makes no guarantees about the animal's temperament, age or health and is not responsible for future damages or injuries caused by the animal.

I agree

I disagree

I give In Our Hands Rescue permission to call my home at any reasonable hour to assure that the animal is being properly treated and cared for.

I agree

I disagree

I agree to keep In Our Hands Rescue informed of my current address and phone number.

I agree

I disagree

I, (name)

am applying to adopt the following animal:

(Name of pet)

(Species)

All animal adoption contracts approved by In Our Hands Rescue are subject to the following terms and conditions:

The adopter agrees that the animal will be kept as a domesticated house pet. This means that dogs are kept indoors except for periods of exercise in a fenced-in area or on a leash. Cats will be kept indoors at all times unless a screened-in porch or similar-type enclosure is available.

The adopter agrees that if the animal is not already spayed or neutered, the animal will be spayed or neutered within 14 days of the date on this contract and proof will be provided to In Our hands Rescue within 21 days of the date on this contract. The adopter further agrees to provide proper veterinary care for the animal.

The adopter grants In Our Hands Rescue the right to make periodic visits to the adopter's premesis for the purpose of checking on the health and general welfare of the animal and to verify that the animal has been spayed or neutered in accordance with the terms of this agreement.

The adopter represents that all household members have agreed to the adoption of the animal and that all household members will abide by the terms of this agreement. The adopter further represents that he/she is eighteen years of age or older.

The adopter represents that he/she has never been subject to legal action for cruelty to or neglect of animals. The adopter further represents that he/she has never owned an animal which has been confiscated by an animal control officer or humane organization for violations of state or local animal control regulations or animal adoption agreements.

If the adopter is a tenant, the adopter agrees to provide written permission from the landlord consenting to the animal aadoption.

If for any reason the adopter is unable to provide care to the animal, the adopter agrees to return the animal to In Our Hands Rescue. The adopter shall not offer the animal for sale or give the animal to any third party without the prior written consent of In Our Hands Rescue.

The adopter agrees that In Our Hands Rescue shall have the right of immediate possession of the animal if, in the judgement of In Our Hands Rescue, the animal is receiving inadequate care, is being improperly housed or handled or has not been spayed or neutered by the specified date.

The adopter agrees to pay In Our Hands Rescue the sum of $300.00 as liquidated damages in the event that the terms of this contract are breached; this liquidated damage value does not bar In Our Hands Rescue from seeking the return of the animal by judicial process or other legal means if necessary. If legal action is instituted, the adopter agrees to pay reasonable attorney's fees and court costs.

The adopter hereby declares that he/she is aware:

(a.) That aniamls are different from human beings in their responses to human actions;

(b.) That the actions of animals are often unpredictable.

(c.) That the animal's behavior may change after it leaves the shelter or other environment and accustoms itself to its new environment;

(d.) That In Our Hands Rescue makes no claims as to the temperament, health or mental disposition of any animal put up for adoption;

(e.) That the adopter herby accepts possession, legal guardianship and responsibility for the animal referenced in this contract and discharges IOHR forever from liability for any injury or damage to any person or property caused in the future by said animal, and from any causes of action, claims, suits, or demands whatsoever that may arise as a result of such injury or damages.

(f.) That there will be NO REFUNDS OF ADOPTION DONATIONS

(g.) That the adopter has received a copy of In Our Hands Rescue's Animal Adoption Contract Terms (Please print for your records).

I hereby declare that I am the adopter whose name is affixed below, and all of the information I have provided is true and complete to the best of my knowledge.

Agree

Disagree

Signature (typing in this box acts as your legal signature)

Indicates Response Required


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