Otter Creek Animal Shelter Adoption Form If you are interested in adopting a pet from Otter Creek Animal Shelter, please fill out the form below and submit it. We will contact you with further questions and action steps. Our intent is to provide a safe and secure environment for animals in our care, to analyze their health and enhance behavior where applicable and to seek ultimate placement in a forever home which supports each animal's unique requirements. In order to be considered for an adoption you must be at least 21 years of age, have knowledge and consent of all adults living in your household, have a valid lD with current address, your landlord's name and phone number (if applicable). Understand that your Otter Creek Animal Shelter adoption application must be approved to adopt an animal and we have the right to refuse any adoption.What is the name of the animal you are applying to adopt?*Contact Name* First Last Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home Phone*Cell Phone*List the first name, last name & birth dates of all adults in the household:*Ages of children in the household (if applicable)Current place of employment and length of time there:* Do you currently rent or own your current place of residence?* Rent Own If renting, what is your Landlord's name and phone number?*Have you ever adopted an animal from a shelter or rescue before?* Yes No If yes, what shelter or rescue did you adopt from, when and the type of animal.Have you ever been refused adoption of a pet from a shelter or rescue?* Yes No If yes, please explain.Please describe why you would like to adopt this pet.*What pets do you currently own?*Please list each pet's name, breed, age, sex, spayed or neutered and location kept (inside or outside). (If you have pets in your household that are not fixed or up to date on their annual shots please do not apply until they are.)What pets you owned in the past 5 years?*Please list each pet's name, breed, age, sex, location kept (inside or outside) and the reason you no longer own the pet.Who is your pet's current veterinarian or previous veterinarian if you do not own pets at this time?Please list name and phone #.Who will be your new pet's veterinarian?*Please list name and phone #.When was your current pet's last visit to the vet?*lf you move in the future what will you do with your pet?*Do you have a fenced in yard? lf not, do you plan on fencing your yard?* Yes, I have a fenced in yard Yes, I plan on fencing in my yard No, I do not have a fenced in yard No, I do not plan on fencing in my yard lf you do not plan on fencing in your yard please explain why.Do you understand that state laws require annual vaccinations for your pet?* Yes No Do you plan on using a chain or rope to tether your dog?* Yes No Not applicable If yes, please explain:Do you plan on taking your new dog to training classes?* Yes No Not applicable Where will your pet be kept during the day and at night?*What type of identification will be placed on your pet?*What arrangements will you make for your pet when you are out of town?*Will you let your pet roam outside unattended?* Yes No Are you willing to spend the time, effort and patience that is required to help this pet adjust to it's new home, family and lifestyle?* Yes No Have you had pets in the past that you have given away or sold?* Yes No If yes, please explain:Under what circumstances would you get rid of your pet?*lf there were circumstances beyond your control that forced you to give up this pet, would you agree to contact us BEFORE placing the pet in another home?* Yes No lf your existing pet or new pet became destructive, what would you do?*What is your plan if your new animal is not completely house trained?*Would you object to a home inspection?* Yes No By adopting this animal, you (the owner) agree to: 1. Accept and keep the dog/cat/horse/rabbit as a companion. 2. Provide human care which includes: giving proper food, water, shelter, exercise & attention. 3. See that a veterinarian gives this pet regular preventative care and immediate medical attention when he/she becomes ill or injured. 4. Not permit the animal to be used for any kind of experimentation. 5. Comply with all state, county, & city laws pertaining to animals. 6. Not hold Otter Creek Animal Shelter responsible for any damages that the animal may do to any person or property. 7. Return the animal to Otter Creek Animal Shelter if you can no longer provide adequate care (food, water, shelter, exercise & attention) to the animal. 8. Understand that adopting an animal is a 10-20 year commitment. 9. Spay or neuter the animal, if not done already. 10. lf for any reason it does not work out with the animal you have adopted, you MUST return the animal ASAP to Otter Creek Animal Shelter (there is no time constraint on this, the animal MUST return.) No refunds are given for any adoption return unless a medical problem develops within one week (7 days) of the adoption. The animal may then be returned with a veterinarian's written and signed statement regarding the problem with the animal, the adopter may request their adoption fees to be refunded. Please make sure you are 100% sure this is the animal for you before you adopt them. lt is very hard on an animal when they are returned. Otter Creek Animal Shelter is not responsible for any expenses incurred in treating the animal after adoption. Otter Creek Animal Shelter reserves the right to refuse adoption of an animal to a home that does not meet the above standards. This includes the right to follow up on animal adoptions and remove the animal if: 1. The animal is not receiving adequate care. 2. The animal is abused. 3. The dog is penned outside day & night, or housed in a garage or out-building all the time with no human interaction. 4. If the animal is not spayed or neutered. All veterinary expenses including shots, medicine, boarding and other liability obtained after the adoption are the sole responsibility of the owner. Aggressive Dog Statement By checking this box, I acknowledge that I have been fully informed that this animal has previously bitten someone and assume any and all risk for the animal. Otter Creek Animal Shelter is not responsible for any further actions of this animal. By signing below I certify that I have read all of the above information and have provided all true and accurate information. I recognize that any misrepresentation of any information may result in my losing the privilege of adopting or keeping an adopted pet. I understand that Otter Creek Animal Shelter has the right to deny my request to adopt an animal, and I authorize investigation of all statements in this application. I understand that this application is the property of Otter Creek Animal Shelter.Adopting Party Name:* Date* MM slash DD slash YYYY
