E-mail Address: Name (First & Last): Street Address: 2nd Line (if needed): City, State, Zip: Daytime Telephone #: Evening Telephone #: This address is a:
Do you have any children? Yes No
Where will this pet live? Mostly Inside Mostly Outside Some of Both How will this pet be exercised? Fenced Yard Fenced Run/Kennel Walks None of these, please explain:
PLEASE TELL US WHY YOU WANT TO ADOPT THIS ANIMAL
IF YOU WORK OUTSIDE THE HOME OR ARE A STUDENT, PLEASE COMPLETE THIS SECTION
Company (or school): Address: 2nd Line (if needed): City, State, Zip: Company Telephone #: Your Job Title:
IF YOU RENT, PLEASE COMPLETE THIS SECTION
Landlord's Name (First & Last): Landlord's Address: 2nd Line (if needed): City, State, Zip: Landlord's Telephone #:
Does your landlord allow pets? Yes NoNot Applicable Have you obtained permission from your landlord for this pet?Yes No Not Applicable Is a pet deposit required? Yes NoNot Applicable If a deposit is required, has it been paid? Yes No Not Applicable
IF YOU HAVE CHILDREN, PLEASE COMPLETE THIS SECTION
List the names and agesof your children How will your children be involved in the life of the Pet?
REFERENCES (must be completed)
Do you have a veterinarian you use now? Yes No If Yes, then: Veterinarian Name: Telephone Number:
Now we need the names and numbers of two people who can vouch for you:
Person #1 Name: Telephone Number: Person #2 Name: Telephone Number:
Thank You!
I agree to adopt (description of animal) from Pets and People: Companions in Therapy & Service. As part of my commitment to this animal I agree to 1. Provide safe clean living conditions for the animal whether in or out side. 2. Abide by all Animal Control Laws of my city or county. 3. Take this pet to my Veterinarian within 3 days for a complete physical and vaccinations. I further agree to complete the full vaccination schedule as recommended by my veterinarian. 4. If the pet is not already sterilized, I will have this pet spayed or neutered within 30 days of adoption. 5. I will provide a safe environment, with appropriate human supervision for my pet when I am away from home. 6. In the event I find I am unable to keep this pet, I will arrange to return it to Pets and People: Companions in Therapy & Service, PO Box 40143, Mobile AL 36640, (334) 866-2226, or surrender it to an appropriate animal control officer. I will not give the pet away. 7. I give permission for Pets and People: Companions in Therapy & Service to call any references listed above, including, if applicable, my current veterinarian. 8. I agree not to hold this organization, its volunteers, or officers liable for any consequences resulting from the behavior of this animal or subsequent illnesses the pet may demonstrate. 9. I agree to donate a minimum of $45.00 to Pets and People: Companions in Therapy & Service to adopt this pet.
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ID for your Pet
Donation options: US Residents can use their credit card at Paypal and get $5 back! or send a check or money order for $45 to:
Pets and People PO Box 40143 Mobile AL 36640
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