T.A.N.Y.A.s INC. Application Form

Today's Date:
Animal's Name:
Animal Type:
Altered:	YES NO	Aprox. Age:
Color/Markings:
Breed:

Adopter's Name:
Spouse's Name:
Email Address:
Are you Over 18?	YES NO
Address:
City:		State:		Zip:
Phone:	111-111-1111		Cell:
Spouse's Cell:
Time at Address:	Years Months

Employer:
Work Phone:
Spouse's Emp.:
Work Phone:

References Name:
Address:
City:		State:		Zip:
Phone:

If adopting cat/kitten, do you plan on declawing? YES NO
If adopting a dog/puppy, will you do obedience training? YES NO

Do you live in a:	House Condo Apartment Mobile
Do you:	Own Rent
Landlord:
Phone:

How long have you looked for a pet?:
Are there any objections to having your facilities inspected?:				YES NO
List allergies by anyone in the household:
Household activity level: Quiet Active Very Active Just Me
Who will be responsible for care and feeding?:
What do you plan on feeding this pet?:
Please identify your local veterinarian:
Vet's Phone:
If bad habits form, what will you do?:
Where will this pet be kept?: House Garage Kennel Fenced Yard
Is your yard fenced?:	YES NO
Type and height of fence:
What arrangements will you make when traveling?:
Please list any pets you own or have owned in past 5 years:
Can you financially afford this pet, healthy or sick?: YES NO

You must agree to all statements below. REMINDER: This is a legal and binding agreement.

I agree to provide adequate love, food, water, shelter and medical care for this animal for his/her entire lifetime.	YES NO

I agree to give this pet at least a one week adjustment period.	YES NO

I agree that for the safety of this pet it must be kept indoors, or in a safe outdoor enclosure.	YES NO

I have given serious consideration to the responsibilities of pet ownership and agree that he/she will be a member of our family for the duration of its life. This includes consulting a professional trainer and/or animal behaviorist.	YES NO

If, for any reason, the adopter cannot keep the animal, the adopter must return this pet to T.A.N.Y.A.’s, inc. This pet cannot be given away, sold or turned into a shelter.	YES NO

If, for any reason, the rescuer determines the adopter to become unfit, the animal will be returned to rescuer immediately upon request. The adopter agrees to the rescue agency’s right to recover said animal, including procurement by police or animal control. The definition of "unfit" is solely the discretion of T.A.N.Y.A.'s, inc.	YES NO

I agree that, as far as can be determined, this animal appears to be in good health. Should I notice any signs of illness within five (5) days of adoption, rescuer must be notified immediately! Failure to do so is a breach of this agreement. This section in no way obligates rescuer to any responsibility, refund, replacement or reimbursement. However, rescuer may be able to answer frequently asked questions and make referrals from a list of current providers.	YES NO

I agree to keep a collar and name tag on my pet at all times and (if a dog) to license him/her with the proper licensing authority in my area.	YES NO

If adopting a cat/kitten, I agree not to amputate digits (de-claw).	YES NO

I agree that no warranties either expressed or implied are made with regards to breed, personality, exact age, appropriateness of a particular animal for the new owner or family, or extended good health.	YES NO

I agree that my donation is not refundable but it is transferable. I understand that donations go to help other homeless pets and to assist T.A.N.Y.A.'s in fighting pet overpopulation.	YES NO

I understand that the animals available for adoption through T.A.N.Y.A.'s, inc. are sometimes rescued from poor conditions. Even though all reasonable steps in proper care may have been taken, some cases of earmites, upper respiratory, other parasites or conditions may occur from change in environment, diet, stress, etc. If any of these present themselves I will notify rescuer and see to proper treatment of my new pet.	YES NO

By signing this contract, the adopter agrees to all the above terms and conditions, to be responsible for the conduct of this animal and will hold the rescuer harmless, blameless and indemnified from any and all claims of liability. The adopter also agrees to pay any and all costs including court costs and attorney's fees required to enforce this contract. The adopter also agrees to pay a $30.00 returned check fee if, for any reason, the bank it is written on returns the item not paid. As of the date of this contract, adopter becomes owner/guardian of subject animal. By placing your initials here you acknowledge a receipt of a copy of this contract.	YES NO

Driver's License #: Expiration: Payment Method:

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