ADOPTION APPLICATION

I hereby acknowledge receiving the animal described below, when according to Dog Law (3 Pa. C.S 459-303) is the property of the Humane Society, of Lebanon County. The OWNER wants to adopt and assume responsibility of the said animal. NOW THEREFORE, in consideration the parties intending to be legally bound hereby, do agree as follows:

1. The Humane Society of Lebanon County will deliver custody and possession of said animal to OWNER on the condition that OWNER will comply all the following. OWNER PROMISES:

a. To provide proper food, shelter, water and humane treatment for this animal at all times.
b. To have the animal spayed/neutered no later than _____________________________________.
c. To not allow the animal to be used for breeding purposes, vivisection not to abandon or to give the animal to any other society or to dispose of it in any way. d. In the event OWNER no longer desires to keep said animal, OWNER may NOT release ownership of this animal to ANY other person without PRIOR WRITTEN permission of the Humane Society. The new owner must qualify under the Humane Society's adoption standards, and transfer of legal ownership shall be done in person at the Humane Society.
d. To immediately notify the Humane Society in the event the animal is lost, stolen, or dead, or if OWNER'S address changes. Should the animal become lost, to make every effort to recover it, including contacting surrounding area animal shelters, local police stations, and to advertise to advertise in at least one newspaper of general circulation for at least three days. Furthermore, if the animal has been impounded, to reclaim it and to pay any redemption fee unless otherwise instructed by the Humane Society.
e. To immediately procure veterinary care if the animal is sick or Injured, and obtain all necessary Inoculations annually, or to immediately return the animal to the Humane Society.
f. To keep a current rabies tag on the collar of the animal at all times. Also If the animal is a dog, a valid dog license must be displayed on its collar if three months or older.
g. To take animal to veterinarian within 72 hours for checkup and any needed vaccinations.

2. OWNER acknowledges the right of any Investigator or agent of Humane Society of Lebanon County to immediately remove the animal from the OWNER'S premises If any of the above conditions and promises are violated. OWNER further grants permission to any investigator or agent of the Humane Society of Lebanon County to enter OWNER'S premises at any time to investigate compliance with the above terms and/or for the purpose of retaking possession, custody and ownership of said animal. In each case said entry shall not constitute a trespass. Furthermore, OWNER promises to surrender the animal and ownership thereof to said investigator or agent upon demand of said investigator or agent.

3. OWNER UNDERSTANDS that the Humane Society of Lebanon County makes no representation, warranty, or guarantee as to the health or disposition of any animal because the Humane Society It uncertain of Its background. The Humane Society of Lebanon County Inquires of known owners whether their animal bites, but the Humane Society makes no representation, guarantee, or warranty that the animal does not bite. OWNER UNDERSTANDS that the animal has displayed no evidence of illness or health programs during Its stay at the Humane Society except as disclosed on the said animal's kennel/cage card and/or by a representative of the Humane Society. The Humane Society of Lebanon County is not responsible for any veterinary bills.

4. OWNER HEREBY CERTIFIES that the information gives to Humane Society of Lebanon County in the adoption application, spay/neuter agreement, or other contractual agreements are truthful and accurate. If owner breaches any of the terms and conditions of this contract, the OWNER agrees to forfeit ownership and agrees that the Humane Society of Lebanon County may repossess this animal. Owner has read all of the above and agrees to be legally bound to the terms and conditions stated. OWNER has received an exact copy of this agreement.

Animal Code # ____________ Species: ____________________ Breed: _________________________

Owner's Name: ___________________________________ Home Phone: _________________________

I have read and understood the requirements above and agree to them.

Owner's Signature: ______________________________________ Date: ___________________

Humane Society Representative: ___________________________________________________