Humane Society
P. O. Box 282 Coleman, TX 76834 325-625-4724
hscc@verizon.net www.HumaneSocietyCC.com
Adoption Agreement
Date ________________________ Animal I.D. __________________ Adoption Fee: ______________________ Additional donation: ______________________ TOTAL: ______________________
I hereby acknowledge receiving from the Humane Society of Coleman County:
BREED: ________________________ SEX ________ COLOR ____________________ I promise to abide by the conditions set forth on the back of this form. I understand that if within ten (10) days of this adoption the animal becomes ill or does not adapt to his/her new home, I may return it to the Humane Society for a refund of costs less a $25.00 Return Fee.
Refund due for spay/neuter of puppy or kitten (if applicable): ______________________
SPAY/NEUTER AGREEMENT: DOG _______ CAT _______ PUPPY _______ KITTEN _______ Approx. Age _____________________ If this animal is too young to be spayed/neutered, I agree to have it altered no later than __________________ (date) or return it to the Humane Society of Coleman County upon request, forfeiting all fees paid at time of adoption. I understand that my portion of the spay/neuter has been paid to HSCC. If you live in the Coleman County area, please call the Humane Society so that an appointment can be made for the surgery with a participating veterinarian.. If you cannot use a Coleman County vet, please forward verification from your veterinarian when the puppy/kitten has been altered. HSCC will then send you the refund noted above. IMPORTANT! Please read and initial the second page of this form before signing!
Adopter’s Signature _________________________________________________ _____________ Address ________________________________________________________________________ Email: _________________________________________________________________________
HSCC Initials: _____________________ Phone No. _______________________
IMPORTANT! Read before signing! 1. 2. 3. 4. 5. 6. 7. 8. 9. I hereby acknowledge receiving the animal described on the reverse. I agree to provide proper food, water, adequate shelter and kind treatment at all times. I have a fenced yard and agree never to chain this dog. I agree to take the animal to a veterinarian for examinations and immunizations as needed; and to procure immediate veterinary care, at my own expense, should the animal become ill or injured. I agree never to carry this animal untethered in the back of a truck. If this is a young animal that has not been spayed/neutered, I agree not to allow the animal to breed, and to spay or neuter the animal in accordance with the the terms for sterilization on the reverse of this form. I agree to license the animal in compliance with the laws and ordinances in force in the municipality in which I reside. I agree to notify the Humane Society of Coleman County if I decide at any time I can no longer keep the animal. I understand the Humane Society expects to hear from you regarding how the pet has adapted to its new home within 30 days of the adoption. If we do not hear, we will call/email you for a report.
10. I understand that the Humane Society of Coleman County cannot guarantee the health, temperament or training of the above-described animal and hereby agree to release them from all liability once the animal is in my possession. 11. I have read this section. I have had it explained to me and I completely understand and accept the rights and obligations involved. ________(initials)
REMEDY FOR NON-COMPLIANCE: It is agreed that the Humane Society of Coleman County retains superior title in said animal limited to and for the express purpose of assuring the animal’s well-being and will only exercise its superior claim in the event it appears to the Humane Society of Coleman County that the proper and humane care as specified in the above adoption provisions is not being afforded said animal, in which case the animal may be taken through
Wormer: __________________________
Date(s)____________________________________________
Canine Disease Shot*________________
Date(s) ____________________________________________ 6 wks. 9 wks. 12 wks. 16 wks.
Other: _________________________________________________________________________________ * We do not give a Bordetella shot, which is for kennel cough prevention.