NASAC1 Adoption Application (Official)

Animal you are interested in adopting

If you want to adopt more than one animal include them below

Animal you are interested in adopting

Applicant

Applicant's First Name *

Applicant's Last Name *

Local Address

Street Address *

City *

State *

Apartment Number (if applicable)

Zip Code *

Phone Number *

Email Address

Alternate Phone Number *

Date of Birth *

Drivers License Number

Will the animal live at your local or permanent address? *

Permanent Address(if different from above)

Street Address

City

State

Zip

Property Ownership

Do you own or rent your home? *

If you do not own the property, list the name and telephone number of the owner or property manager.

Please select your current residence type.

If you answered "other" above, please explain here:

How long have you lived at this address?

If you rent, does your landlord and lease allow pets?

Pet/Placement Information

How did you find out about us?

Have you applied anywhere else for a pet?

If yes, where else have you applied for a pet?

Is this pet for you or someone else?

Do you own other pets at the current time? *

If yes, please list their names, breeds, and ages.

Are all of your pets spayed/neutered/fixed?

How many pets have you owned in the last 5-10 years?

What happened to them?

Are your pets current on their vaccinations?

Veterinarian's Name

Veterinarian's Address, City, State, and Zip Code

Veterinarian's Phone Number

Are you familiar with heartworm and heartworm prevention?

If adopting a dog and it tests positive for heartworms, do you still want to adopt?

Please check the main reason you plan to adopt a pet:

If you answered "other" above, please explain here:

Please describe in detail the pet you are looking for.

Including yourself, how many people live in your household?

Please list the ages of those who live in your home.

Does anyone in your household have allergies to dogs/cats?

If this pet becomes sick/injured, I will be able to pay several hundred dollar vet bills.

Will this pet be predominantly living inside, outside, or both?

Please provide a description of this pet's living conditions.

For what reason(s) would you consider returning/giving up the animal?

Nacogdoches Animal Services reserves the right to refuse the adoption of any animal that the organization feels is an unsuitable/unsafe match for either the animal's or family's health and safety. Falsifying any information on this application will result in immediate denial of your application and may result in denial of all future applications.

Signature *

Pet Adoption Agreement

The animal that I am adopting must have a complete health check by a licensed veterinarian within one (1) week of the adoption date, AT MY EXPENSE. The shelter does not have a staff veterinarian and cannot guarantee the health of the animals. Once the adoption is complete, ALL medical expenses are the responsibility of the new owner. Nacogdoches Animal Services will NOT pay for any medical expenses. *

Nacogdoches Animal Services has administered the first set of vaccinations to the pet that I am adopting, which does not fully protect against diseases that could be transmissible to the pets living within the shelter environment. I also understand that the pet I am adopting will require additional vaccines, at my expense. *

If I must re-home my pet in the future I will contact Animal Services to give them the current owners contact information. If I re-home prior to alteration, I will bring the new owners to the shelter to transfer ownership and legal alteration responsibilities to the new owner. If I do not, I understand that I will remain legally responsible for the alteration of the animal.

I will be a responsible pet owner and abide by all ordinances of the City of Nacogdoches, or the jurisdiction in which I reside, including requirements for rabies vaccinations and pet licensing/registration. *

If my pet is lost or stolen I will notify Animal Services. If it is taken to the shelter, I will promptly reclaim my pet. *

Should the adopted animal become sick or be deemed unsuitable within fourteen (14) day of the adoption date (with proof of the required health check), I have the following options: Return the pet to Animal Services in exchange for another pet, Return the pet within one week of the adoption date for a credit toward the adoption of another animal, or Seek medical treatment at a veterinarian of my choice-AT MY EXPENSE. Animal Services is unable to provide refunds. *

MY ANIMAL WILL BE STERILIZED IN ACCORDANCE WITH STATE LAW. STERILIZATION OF THE ANIMAL IS REQUIRED UNDER CHAPTER 828 OF THE TEXAS HEALTH AND SAFETY CODE. FAILURE TO STERILIZE AN ADOPTED ANIMAL IS A VIOLATION OF THIS CHAPTER AND IS A CRIMINAL OFFENSE PUNISHABLE AS A CLASS C MISDEMEANOR.

I agree: *

Signature *

Spay/Neuter Agreement

I understand that I am responsible for delivering a letter signed by the sterilizing veterinarian describing the animal and the date of sterilization no later than seven days after the animal is sterilized (HSC828.005) *

I understand that if Nacogdoches Animal Services does not receive a letter before the end of the seventh day after the agreed sterilization date that a complaint will be filed against me in the appropriate court (HSC828.008) *

I understand that if the animal dies, is lost or stolen before the sterilization completion date that I must provide a letter to Nacogdoches Animal Services not later than the seventh day after the death or date of disappearance (HSC 828.007) *

Animal Name: *

Microchip number:

I agree to have this animal sterilized no later than (HSC828.004): *

Deadline date:

Animal Name (#2):

Microchip number:

I agree to have this animal sterilized no later than (HSC828.004):

Deadline date:

Animal Name (#3):

Microchip number:

I agree to have this animal sterilized no later than (HSC828.004):

Telephone number:

Deadline date:

Animal name (#4):

Microchip number:

I agree to have this animal sterilized no later than (HSC828.004):

Deadline date:

Signature: *

Driver's License or ID: *

Emergency Contact: (This person may be notified and has my permission to reclaim my animals if they are impounded at Nacogdoches Animal Services following this adoption)

Name:

Emergency contact phone: