Adoption Application

NOTICE: THIS DOCUMENT MUST BE PRINTED, THEN FILLED OUT, THEN SUBMITTED TO HAAU BY EMAIL: haauinc@gmail.com

NO OTHER METHOD WILL BE ACCEPTED.

ADOPTION APPLICATION Humans And Animals United Inc. (hereinafter termed HAAU)
DISCLAIMER – This animal is a rescue animal. By signing this document you hereby agree and understand that Humans And Animals United, Inc. (HAAU) is not responsible, for age, breed, gender, medical conditions or behavior of any animal in which you take full and sole responsibility for the actions and/or damages the animal may cause to life, property or otherwise from the date of your signature.
Today's Date *
INFORMATION ON YOU
Name *
First
Last
Phone
Email *
Address *
Address Line 1
Address Line 2
City
State
Zip Code
Name of emergency contact that does NOT live with you: *
Phone *
INFORMATION ON THE ANIMAL
Name of the animal you are adopting: *
Species: (cat, dog, etc.) *
Male or Female *
Breed / Mix / Color / Markings *
INFORMATION ON ADOPTER
Name *
First
Last
Driver's License Number: *
Age *
Date of birth: *
Phone *
Address *
Address Line 1
Address Line 2
City
State
Zip Code
Name of pet you wish to adopt: *
Name of emergency contact that does NOT live with you: *
Phone *
Your veterinarian's name: *
Phone *
Do you own or rent your home? *
IF YOU RENT, PLEASE PROVIDE LANDLORD’S NAME AND NUMBER
Name
First
Last
Phone
What is your landlord's pet policy?
Do you currently have any pets? *
Pet names:
Pet breeds
Pet's disposition and behavior towards other animals:
Do you have a fenced-in back yard? (yes or no) *
How many feet tall is your fence? (_____ feet tall)
Have you ever surrendered a pet you own to any animal shelter including a "low" or "no kill" shelter? *
yes or no
Do you have any children? *
yes or no
If "yes", please list ages;
How many hours will the pet be alone? *
_____ Hours
Will you crate your pet? *
yes or no
if you have to leave town for an emergency or planned, where will your pet stay? *
How would you deal with behavioral issues such as barking, chewig, destructive behavior, indoor bathroom accidents or unruly leash behavior? *
Please provide the names, emails and phone numbers for 3 personal references:
First *
Second *
Third *
Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment? *
yes or no
SIGNATURES & TERMS – By signing this agreement, you hereby agree and accept the conditions that participating in the application/foster/transport/volunteer process, including home-checks, meet and greets, foster, foster to adopt, events, any and aspects etc., with Humans and Animals United Inc, (HAAU), I assume all responsibility for any and all risks associated with said process. I hereby for myself, my Heirs, Executors, Administrators, or anyone else who might claim on my behalf, or anyone that I bring to the meet and greet/entire transportation process release and discharge HAAU Humans and Animals United, which includes Board Members, Officers, Volunteers and any other parties involved with HAAU from any claims or liability of any kind whatsoever arising out of the rescuing process with HAAU, even though the liability may arise out of the negligence on the part of the parties named in this waiver. This release is given freely and voluntarily by the Participant and is meant to remain in existence throughout the duration of the rescuing process with HAAU. Meet and greet situations, when participating in the application process, during a meet and greet with the animal or any events, any aspects etc., with Humans and Animals United Inc, (HAAU), you hereby assume any and all responsibility for any and all risks associated with said process. You hereby for yourself, your Heirs, Executors, Administrators, or anyone else who might claim on your behalf, or anyone that you bring to the meet and greet release, hold harmless and discharge Humans and Animals United, which includes Board Members, Officers, Volunteers and any other parties involved with HAAU from any claims or liability of any kind whatsoever arising out of the rescuing process with HAAU, even though the liability may arise out of the negligence on the part of any other parties. You hereby and agree that Humans And Animals United, Inc. is not responsible for naming, validating or verifying any dog or other animal breed. • By signing this agreement, I agree to Humans And Animals United Inc. adoption process, will undergo a home check, and interview at the discretion of Humans And Animals United Inc. • By signing this agreement, I understand Humans And Animals United Inc. will check my references including veterinary and personal. • By signing this agreement, I understand there is an adoption donation associated with adoption of a pet from Humans And Animals United Inc. and that it is tax deductible according to IRS 501(c)3 guidelines. I understand this donation will ensure the organization is equipped to rescue another homeless pet and therefore, adoption donations and deposits are nonrefundable. • By signing this agreement, I agree to indemnify and hold harmless Humans And Animals United Inc. against any losses, lawsuits, claims, injury, damages incurred by me or to any persons or property by my adopted pet, once adoption has been completed. • By signing this agreement, I understand that Humans And Animals United Inc. will disclose any of the pet’s health or behavior issues known by the above named rescue group before adoption is completed. • By signing this agreement, I understand that if I no longer want my pet, or am no longer able to care for my adopted pet, I will be directed to surrender my pet back to Humans And Animals United Inc. and provide transport as well as any and all costs required to any location where Humans And Animals United Inc. deems appropriate. • By signing this agreement, I verify all of the above information is true and accurate. CONTROLLING AGREEMENT This Agreement supplements and modifies any and all written or verbal agreements that you may have with the Company. To the extent that this Agreement and another agreement contain conflicting provisions, the provisions in this agreement will control. All other obligations of the parties remain subject to the terms and conditions of any other agreement. SIGNATURE: Please do not sign and submit this form if you do not fully understand and agree with all sections contained herein. By signing and dating this document you hereby understand, agree and accept all sections and terms within this document and you hereby acknowledge that all information provided herein is true to the best of your knowledge. This transaction and agreement is involving your acceptance of taking on the responsibility of an animal which could cause physical or property damage. By signing this document you hereby agree to release and hold harmless Humans And Animals United, Inc. along with any and all employees and associates from any potential issues which may arise legally from you accepting the animal into your possession. For clarity and understanding of the sections within this form, please consult your attorney.
PLEASE UPLOAD A COPY OF YOUR DRIVERS LICENSE HERE:
UPLOAD YOUR DRIVERS LICENSE HERE

Click or drag a file to this area to upload.

Today's Date: *
Click SUBMIT – Then PRINT, SIGN YOUR NAME & EMAIL to haauinc@gmail.com
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