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The Pas and Area Humane Society Adoption Application

  1. Name___________________________Age _______________________
  2. Address____________________________________________________
  3. Mailing Address______________________________________________
  4. Phone Number-Home and work__________________________________
  5. Type of pet wanted____________________________________________
  6. Number and age of all persons who will be residing with the pet________________________________________________________
  7. Why do you want to adopt?______________________________________  

    8. Who will be the primary caregiver to the pet?_______________________

  1. Do you own or rent your residence-if renting does the landlord allow pets-give name

          and phone number of landlord for  reference________________________

          __________________________________________________________

10.Will the pet be kept inside or outside?_____________________________

11.Does anyone  in the residence have allergies?______________________

12.How long will the pet be left alone (day?night) on average_____________

13.Have you ever had pets before-other people in the residence also_______

14.Do you currently have any pets?_________________________________

15.Do you have a fenced yard?____________________________________

  1. If not, will the dog or cat be tied up while outside?______________

  1. How will the pet be taken care of if you have to absent for a long period of time?______________________________________________________
  2. What will you do with your pet if you have to move?__________________
  3. If granted adoption will you obey all Town OCN by-laws relating to pets-do you know what the by-laws are?_________________________________
  4. If granted adoption will you obey all Federal and Provincial rules and regulations pertaining to the care and needs of pet- do you know what they are?___________________________________________________

The Pas and Area Humane Society is committed to finding the most suitable homes for animals in our care.  In accepting this animal you must agree to carry out the following provisions: please initial each clause.

________This pet is being adopted for immediate family with whom signer of application resides.

________All persons that will be residing with the pet are agreeable to having a pet in/on the premises

________No one under the age of 18 will be the sole care giver to this pet-providing food, water, exercise, training, and medical care.

________That having a pet is a 10 to 20 year commitment and that I am committed to this animal’s care and welfare and if for any reason I am unable to keep this animal I will not sell, trade, or give it away without first notifying the society as I will remain contractually obligated by this agreement

_____To provide the animal with suitable outdoor shelter, daily exercise, and regular veterinary care.

_____This pet will be cared for and treated withy respect.

_____Yearly vaccinations will be kept  up-to-date and if not already sterilized at the time of adoption this pet will be sterilized and not be let to breed.

_____This pet will have medical attention if siutations require it.

_____ All costs relating to mecidal care are my responsibility after adoption is conpleter

____The Pas and Area Humane Society cannot quarantee temperament or health of adopted animals(s) and limits their responsibility to the adoption fee.

 

I SWEAR THAT ALL INFORMATION GIVEN BY MYSELF IN THIS AGREEMENT ARE TRUTHFUL TO THE BEST OF MY KNOWLEDGE.

SIGNATURE_________________________________DATE___________

 

I HEREBY DECLARE THAT I HAVE READ AND AGREE TO COMPLY WITH THE TERMS AND CONDITONS LISTED ON THIS APPLICATION.

SIGNATURE_________________________________DATE___________

 

 

OFFICE USE ONLY:

ADOPTION REFERENCE NUMBER:_____________________________

DATE:______________________________________________________

ADOPTION COORDINATOR:___________________________________

NOTES:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 


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