Adoption application

507 N Oak Street

Loogootee IN 47553

812-295-5900

mchs@frontier.com

Animal Shelter

Martin County

Humane Society

ADOPTION APPLICATION

Today's Date *

In signing this form, you are agreeing to the following: 1. Adopter will provide proper and sufficient food, water, shelter, medical care and kind and careful treatment for the animal at all times. The Adopter agrees that if adopting a dog, outside dogs will be kept in a fenced area, not on a chain, and not permitted to run loose and unsupervised. 2. Adopter will keep the animal as a companion and not allow the animal to be used for medical or other experimental purposes or for business purposes. 3. ADOPTER IS FULLY AWARE THAT MCHS MAKES NO GUARANTEES WHATSOEVER AS TO THE HEALTH, TEMPERAMENT, MENTAL DISPOSITION AND TRAINING OF THE ANIMAL. 4. ADOPTER HEREBY FULLY AND COMPLETELY RELEASES MCHS, ITS AGENTS, SERVANTS AND EMPLOYEES FROM ANY DEFECTS OR ILLNESSES THAT THE ANIMAL MAY HAVE OR DEVELOP AND FROM ANY CLAIM, CAUSE OF ACTION OR LIABILITY FOR ANY INJURY OR DAMAGE TO PERSONS OR PROPERTY WHICH MAY BE CAUSED BY THE ANIMAL AND TO INDEMNIFY AND HOLD MCHS HARMLESS AGAINST ALL CLAIMS, INCLUDING, BUT NOT LIMITED TO THOSE ASSERTED BY THIRD PERSONS, FOR ANY INJURY OR DAMAGE TO PERSONS OR PROPERTY CAUSED BY THE ANIMAL. 5. A Martin County Humane Society member is to be contacted and dog/cat returned to location picked up if owner is unable to keep or properly care for the animal. 6. All local and state welfare and animal control laws must be obeyed, including rabies vaccination. 7. This agreement shall be governed by the laws of the State of Indiana. *

A pet can be quite costly. Do you have the ability to pay for food, grooming, vet care, supplies, and/or emergency expenses for the life of this animal? *

Yes

If you answered "yes" to the question above, please explain why.

Have you ever surrendered a pet to any animal shelter? *

Yes

If you answered "yes" or "tried but was unable" to the question above, please explain what animal(s) you adopted or why you were unable to adopt.

Have you ever adopted from an animal shelter before? *

Yes

Tried but was unable

Do you have the consent of everyone in your household to adopt? *

Yes

If applicable, do you have the consent of your landlord, if you are a renter?

Yes

What animals do you currently own? *

Are you 18 years of age or older? *

Yes

Sex of animal you wish to adopt

Male

Female

Name of animal you wish to adopt *

Phone *

Animal interested in *

Dog

Cat

City, State & Zip *

Name: *

Email: *

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Street Address *

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