Shelter Contract

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					Headwaters Animal Shelter                                       Adoption Contract
901 Western Avenue South
Park Rapids, MN 56470
                                                                 TERMS AND CONDITIONS
(218) 237-7100
web site: headwatersanimalshelter.org
Adopter Information                                       Animal Information

___________________________________                       H.A.S. NUMBER
Drivers License Number

                                                          H.A.S. Name
Full Name
                                                          CAT/DOG     BREED_____________
                                                          MALE/FEMALE AGE____________________
Address

                                                          Description
____________________ ______ ________
City                      State       Zip code            If renting:
                                                          Landlord’s Name__________________________
___________________         ______________
Home PH.#                  Cell/Work PH. #                Landlord’s PH. # __________________________

Initial
Please initial:
___ I agree to provide this animal proper and sufficient food, water, adequate shelter, medical care
and kind treatment at all times.
___I agree to comply with all federal, state and local laws, regulations and ordinances applicable to
this animal.
___I understand that adoption fees are NON-REFUNDABLE. If this animal fails to meet my
expectations I may return it to the Headwaters Animal Shelter within 7 days of the adoption date. I
will be issued a Replacement Certificate towards the adoption of another animal. The shelter
reserves the right to deny the issuance of a Replacement Certificate in situations that abuse/neglect
are suspected and/or the animal has died.
___I understand that animals can be unpredictable and that the Headwaters Animal Shelter cannot
anticipate or insure against unexpected conduct of any animal adopted from the shelter. I
acknowledge that the Headwaters Animal Shelter has not made through its agents, volunteers, or
employees any warranties regarding the future condition, temperament or conduct of this animal.
___I accept this animal “as is” and assume all risks and responsibilities associated with this
animal’s ownership.
___I fully and completely to comply Headwaters Animal contract will result officers, volunteers,
a legal document. Failure release the with the terms of thisShelter, its directors,in legal action
agents, the adoptee, employees from the claim, will revert to the liability of Animal Shelter.
against servants, andand ownership of any animal cause of action orHeadwatersany sort or nature,
whether known or unknown, directly or indirectly arising out of or in connection with the adoption,
care, or ownership, maintenance, retention, temperament, conduct, or condition of this animal.
___I understand if I do not adhere to these terms, if I have misrepresented myself, or if I have
adopted this animal under false pretenses, the Headwaters Animal Shelter has the right to reclaim
this animal.
___I have read and understand this contract and agree to its terms and conditions.


_____________________________________                   _____________________________________
Signature of Adopter (must be 18 or older)                    Signature of H.A.S. Representative

DATE______________ FEE____________

				
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Description: Shelter Contract document sample