Adoption Agreement

Animal's Name {field:a_name} Date {other:date} Tracking# Tag#
Type: {field:animal_type} {field:a_if_other} Age: {field:a_age} Gender: {field:gender} Color: {field:a_color} Breed: {field:a_breed}

Adopter's Name: {field:firstname} {field:lastname}
Physical Address: {field:address_p1} {field:address_p2} {field:city_p} {field:state_p} {field:zip_p}
Mailing Address {field:mailing_address_same}: {field:address_m1} {field:address_m2} {field:city_m} {field:state_m} {field:zip_m}
Phone: {field:phone} Email: {field:email}

Conditions Of Adoption
I AGREE:

.. That I will make a donation to AHA of SV to help with pre-adoption expenses   $ {calc:donation}
.. That all adults (and landlord if renting) in the household are aware of this adoption
.. To provide proper and adequate food, water and veterinary care
.. To obey local laws regarding rabies and animal control
.. I must contact AHA of SV if I cannot keep this animal for any reason. It is not to be advertised on any website, social media, newspaper, or radio. Nor is it to be re-homed via any other person or shelter for any reason. IT IS  TO BE RETURNED TO AHA-SV. Contact AHA-SV to make arrangements for its return. {field:i_agree_rehoming}
.. To allow a representative of AHA of SV to examine the animal and its living conditions at any time
.. That AHA of SV and its representatives are in no way responsible for damage which the animal may do to another person or property and no attempt will be made to hold AHA of SV and its representatives liable
.. To have a contained area for the dog and NO PERMANENT TIE OUTS (Will NOT CHAIN)
.. To never transport the animal in the open bed of a truck uncrated
.. To accept the animal AS IS, and that AHA of SV is in no way responsible for the condition of the animal.
.. Give Reference for your Vets Name and/or phone number:
{field:ref_name} {field:phone_r}
.. I have been given a copy of the vet records for this animal:   {field:i_agree_vet_records_received}

I hereby release Animal Humane Association of Star Valley, Inc. and the individuals involved in rescuing and placing this animal from all liability.

Adopter's Signature: Date:

AHA of SV Foster Caregiver: Date:

AHA-SV PO Box 654, Thayne, WY 83127 Hotline 307-883-PETS (7387) www.luckys.place