New Chances Humane Society Adoption Application 
Adoption Application
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Email *
First Name
 *
Last Name
 *
Street Address *
City, State and Zip Code
 *
Phone number *
What animal are you interested in adopting? *
Do you own or rent? *
How long have you lived in your current residence? *
If you rent, please include your landlord's name and phone number. *
Are there breed or size restrictions?  If so, please list below: *

If yes, please specify

*
Are you at least 18 years of age? *
Are there children in your household? *
If so, what are their ages? *
Are there other pets in your home? *
If yes, what type of animals do you have? *
If so, are they up to date on vaccinations and spayed or neutered? *
What qualities are you looking for in a pet? *
Will this be an indoor or outdoor animal? *
How long will this animal be left alone each day? *
Where will this animal be kept when you are away from home? *
What will you do with this pet if you have to move? *
Are you willing to give this pet at least a month to adjust to your home and family? *
Have you ever given up an animal? If yes, why and when? What did you do with the animal? *
References                                                                
Please provide information for two people who have known you at least two years and are not related to you.
Name:
 *
Phone Number:
 *
Relationship to you *
Name:
 *
Phone Number:
 *
Relationship to you *
Veterinarian/Clinic Name *
Phone number: *
Adoption Terms and Conditions

I hereby agree to be bound by the following terms with the New Chances Humane Society (NCHS):  


  1. I am at least 18 years old.

  2.  I understand that this animal may have been abandoned, unwanted, or rescued from dangerous, unhealthy, or cruel situations, and there may be long-lasting effects.

  3. I will be responsible for the care of this animal for the rest of its life, seek veterinary care, as needed, for any illness or injury, vaccinate as prescribed by my veterinarian, and allow the animal to live in my home as part of my family.

  4. If I am unable to keep this animal, I will notify NCHS immediately. If I have had the animal for less than a month, the adoption fee will NOT be refunded. Your adoption fee will be credited towards a future adoption at the NCHS. If I have had the animal for more than a month, the animal will be returned to NCHS at my expense and the adoption fee will be forfeited.

  5. I agree that the NCHS shall not be legally liable for any acts of the animal once it has been adopted. I hereby release and discharge NCHS, its volunteers, officers, board members, donors, and supporters for all acts, omissions, claims, or causes of action of any kind arising from the adoption of this animal.

  6. I agree to hold harmless NCHS for any medical conditions or other issues this animal may have or may develop after I assume ownership

Date: *
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Applicant's Electronic Signature *
Animal Information- For NCHS Use Only
Animal Name, Description
Date of adoption
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Adoption Fee/Payment Type
Submit
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