" Never doubt that a small group of thoughtful, committed citizens can change the world;

indeed, it's the only thing that ever does" - Margaret Mead.

COLUMBUS PET RESCUE

ADOPTION APPLICATION/AGREEMENT

In which pet are you interested?

Located on/at? web site Petfinder/Adopt-a-Pet

Petsmart Grove City Petsmart Hilliard Petsmart Polaris

Adopter’s Name:

Driver’s License #

Address

City State Zip

Home Phone Work Phone Cell Phone

Email address:

How long have you been employed at your current occupation? years months

Names and relationship of all others in household (include ages of children)

Who will be responsible for the pet’s care?

Does everyone in the household agree with this adoption?

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Type of housing (check all that applies): Own Rent Live w/Parents

Military House Condo Apartment Mobile Home

Length of time at current address: years months

Landlord name and phone number (if applicable)

Where will the pet be kept during the day?

Where will the pet be kept at night?

On average, how long will the pet be left alone each day?

Do you have a fenced yard? If so, how tall is the fence?

(Dogs Only) Are you familiar with crate training?

(Dogs Only) How will you exercise the dog and how often?

How much money do you expect to spend each year on your pet?

How will you provide for your pet if you are obligated to move/travel?

Please describe all current pets:

Please describe all other pets previously owned and where they are now?

Names of 2 personal references and their phone numbers who can attest to your abilities as a pet owner.

Name of veterinarian: Phone

(Dogs Only) Have you had your dog impounded, or been cited for violating dog laws?

If so, please explain:

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Reason for wanting a pet (check all that apply): Gift Watchdog Hunting

Companion for myself Companion for another pet Other:

What is the maximum amount of time you are willing to give the pet to adjust to you, your family,
and their new environment?

For what reasons would you consider giving up or getting rid of a pet?

Would you be interested in getting involved with Columbus Pet Rescue?

Would you be interested in fostering?

INITIAL THAT YOU BOTH (if applicable) UNDERSTAND AND WILL ADHERE TO THE
FOLLOWING:

I hereby testify that I am 21 years of age or older and am financially and physically able to care
for this pet. I understand that proper food, veterinary care, bedding, toys, crate and so on can be costly
and I am able to meet these requirements.

This Pet is being adopted solely as a member of my family and shall reside in my home and will
not be housed outside unsupervised.

I understand that if the information contained herein is in any way found to be less than truthful,
my application can be refused and said adopted pet shall be relinquished to Columbus Pet Rescue without
refund of the adoption fee.

I understand that Columbus Pet Rescue reserves the right to refuse the adoption of any pet to any
person for any reason. Columbus Pet Rescue also reserves the right to reclaim pet without question if
abuse or neglect is suspected or proven.

I understand the health of this pet is not guaranteed and I agree to call my veterinarian to schedule
a wellness exam and whatever other medical care is needed for my new pet. I agree to provide the pet
with yearly veterinary care including all recommended vaccinations, flea/tick, dental and heartworm
preventative. I understand that Columbus Pet Rescue will NOT REIMBURSE ME FOR ANY FUTURE
VETERINARY EXPENSES INCLUDING THE WELLNESS CHECK.
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 I understand that introducing a new pet into a household with existing pets can result in
behavioral changes in both the incoming and resident pets. I have considered this possibility and am
prepared to deal with it to make the necessary adjustments of introducing this pet to its new home as easy
as possible on the pet and the family.

This pet will never be sold, given away, abandoned or otherwise disposed of to any person,
dealer, retailer, auction, institute or other entity for any reason. I agree to return this pet to Columbus Pet
Rescue if I decide at any time, for any reason, that I can no longer care for the pet and I understand the
adoption fee nor any other costs associated with this pet will NOT BE REIMBURSED (except as
specifically stated below).

In consideration in adopting this pet, I promise and agree to be solely responsible for this animal
and to indemnify and hold harmless Columbus Pet Rescue, including members and volunteers for any and
all claims of liability for the conduct of this dog on or after the date of the adoption. I, the undersigned,
agree to all of the above terms of this contract and understand that non-compliance with these terms gives
Columbus Pet Rescue the right to reclaim the pet without refund of the adoption fee.

Each pet will have the following medical treatment (unless otherwise specifically disclosed to the
potential adopter):
DOGS CATS
SPAY/NEUTER SPAY/NEUTER
HEARTWORM TEST (if applicable) FELV/FIV TEST
Rabies (must be between 3-4 months) Rabies (must be between 3-4 months)
Canine Distemper/Parvo Vaccine Feline Distemper Vaccine
Worming Medication Worming Medication

The undersigned further agrees and intends that this “Release of Liability and Indemnification” shall
apply to all known, unknown, and unanticipated damages resulting from my adoption, ownership or
control of said Animal(s). “This is a binding contract, enforceable by Civil Law”.

IN THE EVENT, WITHIN 14 DAYS OF THE DATE THIS IS SIGNED, YOU NOTIFY US THAT
YOU DO NOT WANT TO ADOPT THIS PET FOR ANY REASON, YOUR ADOPTION FEE WILL
BE REFUNDED (IF REQUESTED) UPON THE SAFE RETURN OF THE PET TO COLUMBUS PET
RESCUE. IF PAID BY CHECK – THIS ADOPTION IS NOT FINAL UNTIL YOUR CHECK HAS
BEEN DEPOSITED AND CLEARED. IF THE CHECK IS RETURNED – THE PET MUST BE
IMMEDIATELY RETURNED TO COLUMBUS PET RESCUE AND THE ADOPTION IS NULL
AND VOID.

“ADOPTORS” I have read and agree to the terms of this Agreement.

Signature(s) Date

________________________________________________________ Date ____________________

_________________________________________________________________________________

ACCEPTED ON BEHALF OF COLUMBUS PET RESCUE BY:

____________________________________________________________________________________

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