First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Work Phone
x

Cell Phone

Alt Email

Drivers license number

Are You a Veteran?

Who all lives in the home? Please provide name, age and gender of everyone. *

Does anyone in your home have allergies?*
Choose one: Yes No

Interested pet

Why do you want this pet?*

What other pets reside in the home? (How many? What kind?)*

Have you had pets in the last 10 years?*
Choose one: Yes No

If these pets are no longer with you, please tell us why.

Do you own or rent your residence?*
Choose one: Own Rent

How long have you lived there?*
Choose one: Less than 1 year 1 year 2 years 3 years 4 years 5 -10 years 10+ years

Do you plan to move in the next few years?*
Choose one: Yes No

Do you live near a busy road?*
Choose one: Yes No

Do you have a fenced in yard?*
Choose one: Yes No

Please provide name and phone number of landowner/landlord if applicable.

Are there any breed restrictions in your area or by the landowner?*
Choose one: Yes No

If you rent, do you have permission from the landowner/landloard to have a pet?*
Choose one: Yes No Not applicable

Who is your current veterinarian? Please provide name and phone number. (We do vet checks) Also date of last visit. Most adoptions require that you have a vet reference. *

Please list the names and contact information for 2 references.*

Where would this pet spend most of its time?*

How many hours a day would this pet be left alone?*

If the dog is not housebroken, how to you plan to handle this task?*

Who will be the primary caretaker?*

How many hours a day would you spend with this pet?*

What kind of responsibility do you feel pet guardianship involves?*

If you must give up your pet, what would you do?*

When adopting this pet, do you realize the health maintenance costs per year and will you be able to continue this for the health of your pet?*
Choose one: Yes No

*PLEASE NOTE:  A lot of the dogs at the shelter we have limited history on and the breed of the dog is not 100%.

One application per pet.

You must be 18 years of age to fill out this application

These pets that are up for adoption have been traumatized and/or abused and we try our very best to place them in loving forever homes so as not to add to the pet's bad experience.  We are an all-volunteer organization and sometimes it takes time to review applications.  Please be patient.  If you don't hear from us in a timely manner, please contact us. 

I agree to keep this dog as a pet, to be exercised regularly.  I understand that chaining this pet outside on a continuous basis is not acceptable.

I agree to assure the health and welfare of this pet by annual veterinarian check ups, vaccinations, worming and whatever else this animal may require to sustain it’s health and well being.

I agree to surrender this dog to Crossed Paws Animal Shelter, if CPAS deems it advisable to the health and welfare of the pet.

I agree not to sell, trade, or dispose of this dog for any reason. If for any reason, I cannot keep this dog, it will be returned to CPAS.

I understand that the temperament, health, trainability and personality of this dog can not in any way be guaranteed and that CPAS does not make any warranties, expressed or implied, including merchantability or fitness for a particular purpose.

I understand that Crossed Paws Animal Shelter is a non-profit organization and I do hereby release it from all responsibilities or liabilities of any kind.

I agree that I have received a written health record from CPAS that has recorded vaccinations/worming/treatments/spay or neuter information.

I agree to send updates and pictures of my new family pet to Crossed Paws at least twice a year either by Facebook, messenger, text, or e-mail.

I agree that for any reason if I am not able to keep this pet or no longer want this pet, I will contact Crossed Paws and return it to them. The current adoption fee for this pet is $150.

I understand that I am entitled to a full refund if the pet is returned in safe, healthy condition within 2 weeks of this contract.

NO REFUND will be issued after 2 weeks of the date of this contract, and if the pet appears abused or neglected.

If by chance this dog does not have all of his/her shots, spayed/neutered I being the current owner of this dog accepts all responsibilities in getting the animal vet checked, all shots, and spayed and neutered within the appropriate time frame. I will provide CPAS with the date when the animal is to be seen by the veterinarian so CPAS can contact the veterinarian to assure that agreed terms are being fulfilled.

I CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT. I UNDERSTAND THAT ANY FALSIFICATIONS OF THE ABOVE INFORMATION WILL BE GROUNDS FOR DENIAL OF THIS ADOPTION APPLICATION. I HAVE READ THE ENTIRE DOCUMENT AND FULLY UNDERSTAND. I AM ABLE AND PREPARED TO OFFER THIS PET A LOVING HOME FOR THE DURATION OF HIS/HER LIFESPAN. IT IS ALSO UNDERSTOOD THAT BY SIGNING THIS ADOPTION AGREEMENT I DO NOT HOLD CROSSED PAWS ANIMAL SHELTER RESPONSIBLE FOR ANY ACTS, BEHAVIOR OR CONDITIONS THAT THIS ANIMAL MAY ENDURE. SIGNING THIS FORM MAKES ME THE PRIMARY OWNER AND COMPLETELY RESPONSIBLE FOR THIS ANIMAL.

Please type your name as your signature and date. *