Dog Adoption Agreement - Pet Haven of Minnesota

Date*

Adopter's Email*

Animal Name*

Animal ID*

*Please see pre-adoption packet.

Microchip Number*

Microchip Company*

Other Microchip Company*

Please specify

Date of Birth*

Disclaimer: Animal's age may be an estimate given their unknown history.

Gender*

Male
Female

Name of Vet Clinic(s) Where Animal Received Care*

Vet Care Received

Rabies
DHPP
DHPP Booster
Spayed/Neutered
Bordetella
De-Wormer
Flea/Tick Preventative
Heartworm/Lyme Test
Heartworm Preventative

Additional Vet Care Needed

e.g. boosters, follow-up visit, etc

Medical Notes

Food Preferences

Disclosures

Anything special to note about this dog can be shared below.

Animal Origination*

e.g. Shelter, Surrender, Reservation

Contact Info for Questions*

If you have questions about the animal you have adopted, please contact (include name and email or phone)

To Be Completed By Adopter:

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Primary Phone*

Secondary Phone

Email*

How did you find out about this animal?*

I will be paying the adoption fee by:*

Cash
Check
Credit Card

Agreement

Please check "I have read and understand" after reviewing each statement below.

I am adopting this animal to be my pet and companion. I will care for, feed, house and treat this animal in a manner acceptable to and in accordance with city ordinance and state law*

I have read and understand

I understand that Pet Haven has a lifetime commitment to the animals it places into new homes. If for any reason I cannot keep the animal I have adopted, I may notify Pet Haven. I understand that Pet Haven will work with me to find an appropriate new home or make arrangements for my pet to be returned to Pet Haven.*

I have read and understand

I understand that during the 10 days following signing this Adoption Contract Pet Haven will provide advice for resolving behavior problems and will allow the animal to be returned and the adoption fee refunded. Accordingly, I will notify Pet Haven promptly of any health or behavior concerns during the first 10 days following the signing of this Adoption Contract.*

I have read and understand

I understand that Pet Haven will cover the costs of treatment (including office visit, diagnostic tests, and medication) for the following conditions, should they arise within 10 days of signing this Adoption Agreement: Upper Respiratory Infection (Kennel Cough/Canine Infectious Respiratory Disease, Feline Upper Respiratory Infection), Eye Infection, Ear Infection, Skin Infection, Pain Control (related to surgical sterilization), External Parasites (Fleas, Mites, Lice)*

I have read and understand

Pet Haven requires all animals it adopts out to be spayed or neutered. I understand that if I am adopting an animal that has not been altered at the time of adoption, I agree not to breed or put her/him in a situation where he/she could breed or become pregnant. Pet Haven will cover spay/neuter surgery if it is done by an approved Pet Haven vet provider. Pet Haven may prearrange this for me. I will abide by the schedule Pet Haven arranges. If I choose to use a vet that is not approved by Pet Haven, I will be responsible for paying for the spay/neuter surgery and sending records to Pet Haven. I understand that in addition to the adoption fee, I am paying a deposit of $75.00, which will be returned to me after the spay/neuter surgery arranged by Pet Haven is complete.*

I have read and understand

In order to be reimbursed for the above-mentioned conditions, I agree to provide Pet Haven all necessary billing statements and vet records pertaining to the treatment of my animal*

I have read and understand

If an illness or condition other than those mentioned above is suspected, I may have my veterinarian diagnose and treat the condition at my expense or I can return the animal within 10 days of signing this Adoption Contract and receive a refund of the Adoption Fee.*

I have read and understand

Following the date of this adoption, on at least an annual basis, I agree to have this pet examined by a veterinarian and vaccinated according to the schedule the veterinarian and law requires, and to arrange for the retention of all records regarding vet visits and immunizations.*

I have read and understand

I understand that if I am adopting an animal within their 14 day surgery recovery period, I am responsible for following post operative instructions. Failure to do so may result in incision complications for which Pet Haven is not liable.*

I have read and understand

I will not euthanize this animal unless recommended by a veterinarian, and only when there is pain or suffering that cannot be alleviated, excessive destructive behavior that cannot be resolved, or aggressive behavior that presents a clear threat to the safety of people or other animals.*

I have read and understand

I understand that a licensed veterinarian has examined this animal on behalf of Pet Haven prior to my signing this Adoption Contract. I am aware that this animal could be carrying illness, disease, condition or disposition that has not been detected by this veterinarian exam or by Pet Haven, and that the medical records provided by Pet Haven are not a guarantee of medical health.*

I have read and understand

I hereby release and hold harmless Pet Haven, its Officers, Directors, Staff, and Volunteers from any and all claims, causes of action, damages, injury or liability in connection with this adoption.*

I have read and understand

Pet Haven is proud to be part of the Hill’s Food, Shelter & Love program. We offer all our adopters the opportunity to participate in the Hill’s New Pet Parent Program. As part of program, you will receive an email with a link to Hill’s New Pet Parent website, and more information about the Hill’s food, the Adoption Kit and other tips for new pet parents. Pet Haven will register adopters for the Hill’s New Pet Parent program and other offers and promotions. You may opt out at any time.*

I have read and understand

By entering my name below, I acknowledge that I have read and agree to this Adoption Contract and that I am of legal age and have the capacity to make a binding contract.

Agree to the above section with your name:*

Date*

Pet Haven Representative*

First Last

Please note: Pet Haven will register your animal's microchip post-adoption as a service to all adopters.

Pet Haven's Return Policy

10-day grace period policy: If, within the first 10 days of adoption you determine your adopted pet isn’t a good fit or you find yourself unable to provide necessary medical care, you may return your animal to Pet Haven and receive a 100% refund of your pet’s adoption fee. Please understand that if you choose to return the animal you will not be able to re-adopt the animal at any time.

Post 10-day return policy: If you decide to return your adopted pet to Pet Haven after the 10-day grace period, Pet Haven will make every effort to find a suitable foster home for the animal as quickly as possible. Adopters are welcome to place their animal with friends and family - returning to Pet Haven is not a requirement.

Since Pet Haven is a foster-based organization with limited foster homes, we request at least 14 days to secure suitable placement in a foster home. We may ask that owners provide boarding for their animal in the interim, if necessary.

If an animal has posed a threat (i.e. bite history) Pet Haven may request the animal to be assessed by a professional trainer to ensure the animal is safe to place in a new home. Pet Haven may also offer to provide support services (such as offering a professional trainer assessment or a discounted class at a local training facility) to owners willing and able to work with through their animal’s behavior issues.

Once an animal is returned, Pet Haven becomes the legal guardian and is solely responsible for using our judgment and discretion in placing an animal, including euthanasia decisions.

Would you like a copy of this agreement emailed to you?

Yes

You should receive a response from us within 24-48 hours. If you have not received an email, please check your spam folder.

Name

This field is for validation purposes and should be left unchanged.