Last Chance Adoption Application

Printable LAST CHANCE Adoption Agreement

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LAST CHANCE Adoption Agreement

Please complete this form in it's entirety to avoid delays in processing

Name*

Mailing Address*

Physical Address (if different)

Home Phone

Cell

Work

Email Address*

Animal ID

Color of Animal

Breed of Animal

Sex of Animal

MaleFemale

Vet Reference

Please provide Vet's full name and telephone Number

Please provide two personal references NOT living in your household:

Full Name, Address, Telephone Number

Signature and Hold Harmless Agreement*

The pet you are about to adopt has been rescued by you directly from our local pound. This pet has had no physical examination or veterinary care that The Animal Refuge Foundation is aware of. This pet has NOT been in The Animal Refuge Foundation of Wayne County’s foster home system to receive any evaluation regarding health status or any behavior issues. The Animal Refuge Foundation of Wayne County has had little to no interaction with this animal and can in NO WAY GUARANTEE the health status, temperament, or behavior of this animal. The Animal Refuge Foundation of Wayne County has no knowledge of any past history of said animal. Adopting this pet entails that you, the new owner, take full responsibility of any health care issue, and any temperament or behavioral issue. Again, The Animal Refuge Foundation of Wayne County makes no guarantee on this animal and in no way assumes any liability with this adoption.

Date of Application

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