A Program of the Central Pennsylvania Animal Alliance
	Application to Adopt Chip Pet's Name:  Name  Address  City/State/Zip  Home Phone  Work Phone  Cell Phone Email Address  Date of Birth Employer  Occupation  Do you own or rent your home?  Rent          Own If you rent, please list the name of your Landlord or Apartment Complex and Phone Number: List the people who live in the household by name, age and relationship (including yourself):   Name       Age    Relation Name       Age    Relation Name       Age    Relation Name       Age    Relation Name       Age    Relation Name       Age    Relation Name       Age    Relation Name       Age    Relation Name       Age    Relation Name       Age    Relation Have you or anyone in the household even been convicted of a Misdemeanor or Felony offense:  Yes No If yes, please describe: Why are you interested in getting a new pet at this time: Describe the other pets in the home (include name, age, physical condition, current illnesses, etc): Explain who in the household will care for the pet: What type of training would you like to do with your pet? How will you deal with housetraining? Describe other aspects of how you would care for the pet such as feeding and grooming: Have you ever given up or surrendered a pet to an animal welfare organization? Please explain the circumstances if applicable:  Yes       No Have you ever given or sold a pet to a friend, relative or neighbor. Please explain the circumstances if applicable: What steps would you take if your pet misbehaved? For example, had an accident in the living room, ruined a piece of carpet, etc: Describe your experience in dealing with an animal that is ill. If you have never had a sick pet, describe what you might do if you found your pet had a serious illness: Describe what you would do if you found you could no longer care for your pet: How will your pet be exercised? If you are adopting a dog, include whether or not you have a fenced in yard and the details of where and how often you will walk the dog: How will the pet be cared for while you are away from the home for extended periods, for example vacation: Veterinary References Veterinarian   Phone Address  Name of pet(s) treated Reference #1: Please list the name/address/phone# of a personal reference who has knowledge about what it means to be a good pet owner and also who knows you and has seen you interact with pets (preferably not a boyfriend/girlfriend): Name       Phone  Address Reference #2: Please list the name/address/phone# of a personal reference who has knowledge about what it means to be a good pet owner and also who knows you and has seen you interact with pets (preferably not a boyfriend/girlfriend): Name       Phone  Address If this is your first pet as an adult but you had pets while growing up, please list your parents' names and phone number: Name       Phone  Please list your parent's family veterinarian's name and phone number: Name       Phone  Upon submission of this Adoption Application, I give permission to Castaway Critters to contact my veterinarian. I further certify that all statements made by me are true and correct and I understand the adoption requirements and terms and conditions:   I Agree     **REQUIRED** Terms and Conditions of the Applicant should they be approved to adopt a cat or dog: 1. Adoption fees are nonrefundable. 2. I agree to provide a safe and loving home for the Pet(s) for the lifetime of the Pet(s). If at any time, and for any reason, I am unable to continue to provide such a home, the Pet(s) shall be returned to Castaway Critters, The James A. Hueholt Memorial Foundation for Animals immediately. 3. To notify Castaway Critters, The James A. Hueholt Memorial Foundation for Animals of any urgent problems with the dog or cat within the first 7 days of adoption. You must not wait for our call to provide notice of any problems or difficulties, as we may need to address them immediately. 4. If I am unable to care for the Pet(s) at any time, I will not sell the Pet(s) or release the Pet(s) to a shelter. If the Pet(s) are transferred to relatives, friends, acquaintances, or any other person(s), I will notify Castaway Critters, The James A. Hueholt Memorial Foundation for Animals, as such and provide the full name, address and phone number of the person(s) adopting the Pet(s). 5. I agree to keep the Pet(s) indoors and to safeguard the dog or cat from loss or mishap. This means not allowing the dog or cat to run at large unsupervised. I agree to immediately notify Castaway Critters, The James A. Hueholt Memorial Foundation for Animals at (717) 503-8371 or (717) 944-3255, Petfinders (800) 666-5678, Pet Watch, (212) 744-6775, Petline (800) 564-5704, and the Humane Society or SPCA if the dog or cat is lost, and to make every reasonable effort to recover the dog or cat. 6. I agree to provide medical care, including yearly examinations and vaccinations, as directed by a licensed veterinarian. 7. I agree to take the pet to a veterinarian within 7 days of adoption in order to alert Castaway Critters of any serious illnesses of concern to you upon adoption. For any serious illness or veterinary special need that you have not been informed of prior to adoption, Castaway Critters will exchange the animal within that time period. The adoption fee is not refundable unless upon discretion of the director. Subsequent illnesses are the responsibility of the adoptive owner. Serious illnesses do not include Upper Respiratory Infections, booster shots, ringworm, minor skin irritations or allergies, ear mites, worms or other parasites. New owners should expect to invest some money in veterinary care upon their first veterinary visit. Many standard health measures for pets require multiple treatments – especially those for worms, fleas and ear mites and though we treat for such issues, we cannot guarantee that they are completely taken care of in an adopted pet. Please be aware that upper respiratory infections and viruses are very common in the cat population, though they are generally successfully treated. It is especially important to take small kittens to the vet upon first noticing such a problem. We do the best we can to identify any health issues, but Castaway Critters cannot guarantee the absence of upper respiratory infection or virus in cats or kittens. 8. If the Pet(s) is not yet spayed or neutered, I agree to have the surgery performed. Ownership of the pet cannot be officially relinquished by Castaway Critters, The James A. Hueholt Memorial Foundation for Animals until the new owner provides proof of spay/neuter. Please submit proof of spay/neuter as soon as the operation is performed to avoid additional costs on our part. If we have not received proof of spay/neuter, we will remind you of the need to spay or neuter your pet when near the time that it is 6 months old. Most veterinarians recommend spay/neuter at 4-6 months of age. Spaying and neutering prevents health problems in your pet such as ovarian and testicular cancer and will help you avoid behavioral issues such as spraying or leg lifting. You must mail or deliver proof of spay or neuter to us within 30 days of the notice or we will seek return of the pet. A copy of the veterinary report can be used as proof of spay/neuter. If we must file a complaint for return of the pet, you will be held responsible for paying the costs for such an action. In addition, if we cannot obtain return of the animal, you are responsible for compensating us in the amount of $250 per pet over and above the costs of the civil action. 9. I understand that Castaway Critters, The James A. Hueholt Memorial Foundation for Animals, has limited information regarding the temperament, age, or habits of the Pet(s); I agree to accept the Pet(s) as described. The Agreement shall be binding upon the assigns, heirs, executors and administrators of the parties hereto. The parties hereto have hereunto set their hands the day and year first above written. Failure of the New Owner to comply with the provisions of this Agreement shall result in the forfeiture of the Pet(s) to Castaway Critters, The James A. Hueholt Memorial Foundation for Animals or, in the event that the pet cannot be recovered, reimbursement for the value and the full extent of expenses that Castaway Critters, The James A. Hueholt Memorial Foundation for Animals incurred in the care and treatment of the dog or cat, a minimum of $250 per animal. Do you agree to these terms and conditions:    I Agree     **REQUIRED**
	Hounds of Prison Education A Program of the Central Pennsylvania Animal Alliance