You are free to print this sample form for your own personal use. Use this form as a guide. Please add any questions or stipulations that are necessary.
It is important to make you aware that there are unscrupulous people who operate in rings to collect cats, dogs and other animals for abusive situations. The danger is that these people appear to be animal lovers and could easily fool you. They sometimes bring children to portray a "perfect family" image. Therefore, it is important to check all references, including a veterinarian reference, and do a home check BEFORE releasing an animal into a stranger's care. Follow-up checks are also necessary.
What Could Happen To An Animal From A "Free To Good Home" Ad?
- Tortured or killed by animal abusers
- Sold to research labs for experiments
- Used as bait for fighting dogs
- Victims of neglect
- Used as free food for snakes or other animals
Please leave this header on this document if forwarding.
COMPANION ANIMAL ADOPTION AGREEMENT
ADOPTER'S INFORMATION:
Name:
Address:
City:
State:
Zip Code:
Phone Number:
References Checked: Y/N
Homecheck Completed: Y/N
________ (initial)
INFORMATION ABOUT ADOPTED ANIMAL:
Cat/Dog/Other
If other, specify:
M/F
Date of Birth:
Color:
Other description:
ADOPTER'S AGREEMENT
- I agree that the animal is being adopted for myself and will not be sold, adopted, or given to another party. _________ (initial)
- I agree that the animal will not be allowed outdoors without proper supervision. When taking my dog outdoors, they will be on a secure harness and wear proper ID. _________ (initial)
- (If adopting a cat) I agree that I will not declaw the cat or allow the cat outdoors. _________ (initial)
- (If adopting a dog) I agree that this dog is to be a companion animal, not a guard dog. The dog will live inside my home, not outdoors. _________ (initial)
- I agree to care for the animal in a humane manner and be a responsible animal guardian. This includes supplying adequate food, water, shelter, attention, and medical care. _________ (initial)
- I agree that if at any point I can not keep the animal, I will return him/her to the original rescue without requesting a fee. _________ (initial)
- I understand and agree that the current rescue makes no guarantees about the animal's temperament and is not responsible for future damages or injuries caused by the animal. _________ (initial)
- I give the current rescue permission to call my home at any reasonable time to assure that the animal is being properly treated and cared for. _________ (initial)
- I agree to keep the rescue informed of my current home address and phone number. _________ (initial)
I agree that all statements I have made on this form are true. If it is found that any statements I have made on this form are not true the adopted animal can be confiscated.
Name:
Address:
City:
State:
Zip Code:
Phone Number:
Driver's License Number:
License Plate:
Adopter's Signature:
Date:
Current Guardian's Signature:
Date:
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