*JCAS Adoption Application

Animal you are interested in adopting

Applicant's First Name

Applicant's Last Name

Street Address

City

State

Apartment Number (if applicable)

Zip Code

Phone Number *

Email Address

Alternate Phone Number

Date of Birth

Drivers License Number *

How did you find out about us?

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?

Are your pets current on their vaccinations?

Have you ever turned your dog or cat into a shelter?

If yes, please explain?

Veterinarian's Name

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

Veterinarian's Phone Number

How do you feel about having pets spayed/neutered?

Are you familiar with heartworm and heartworm prevention?

If you have pets, will they adjust to a new pet in the house?

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

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

Do you own or rent your home? *

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, please provide the Agency Name/Landlord Name, and Phone Number *

Are there children that live in your household? If so please list number of children and ages. *

Please list the full name, age, & relationship of those who live in your home 18 years and older.

Is everyone in your household aware that you are planning to adopt a pet?

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

Employment Status *

If you chose "other" above, please explain:

If you are employed, what is your current occupation?

On average, how many hours per day will your pet be left alone?

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

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

Do you have a completely fenced-in yard? If so, what kind of fence?

If you answered "other" above, please explain:

If you do not have a fenced yard, how will you let the animal out?

Are there times when the animal will be tied/chained up?

If yes, when will they be tied/chained up?

I will keep the animal up-to-date on it's Rabies Vaccination yearly for the remainder of its' lifetime as required per Indiana State Law. *

If no, please explain:

Have you ever been convicted of abuse or neglect of a child or animal?

If yes, please explain:

What arrangements will you make for the care of your pets in case of an emergency?

If you answered "other" above, please explain:

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

What would you do with your animal if you had to move?

If you answered "other" above, please explain:

Are you willing to take responsibility for this animal for the next 10-20 years?

If no, please explain:

I agree to pay the adoption fee of $50 for this animal, in addition to any medical expenses the shelter has incurred for this animal. I understand there is no refund of adoption fee/medical fee. I agree to provide a prepaid receipt with an appointment date for the spay or neuter and rabies vaccine before the adoption is complete and the animal is released into my care. I also agree to not use this animal for breeding purposes. I agree to provide the animal with clean water, high quality food, adequate shelter, and kind treatment at all times. I will provide this animal with medical attention from a veterinarian for examinations and immunizations if and when needed. I agree to provide immediate veterinary care at my own expense should the animal become ill or injured. *

Within sixty days of taking custody of the animal, I will return the completed and signed Veterinarian’s confirmation of Spay/Neuter and Rabies Vaccination postcard to JCAS by the required Date. If I do not return the Spay/Neuter/Rabies Vaccination postcard completed and signed by my Veterinarian by the required date, this will automatically breach the Foster- to-Adopt contract. I understand the adoption is not complete until confirmation is given to JCAS. It is considered a Foster-to-Adopt until the animal is Spayed/Neutered and has its Rabies vaccine, unless prior authorization has been given due to the animal’s medical or age issues. I understand J.C.A.S. cannot be held responsible for any health, mental, or temperament problems found in the animal after Foster- to-Adopt or finalized Adoption from Jasper County Animal Shelter. I agree to abide and comply with all animal related Indiana State Laws, Jasper County Ordinances and local City Ordinances. *

I understand that by not following all of this agreement that I am in Breach of this Foster-to-Adopt contract, the animal will then be reclaimed by the Jasper County Animal Shelter and Control and a $100.00 Breach of contract will be assessed to the signer of this agreement. I understand that JCAS is a small facility with only 7 dog kennels and 7 cat cages and if I can no longer adequately care for this animal an Owner Surrender fee of $125.00 will be due at the time of Surrender warranting JCAS has space. Before a return is approved and scheduled, I will be required to contact my Veterinarian, local animal rescues, and training facilities to find a solution and/or placement for this animal. *

I understand that if the animal I am adopting bites, harms, or otherwise inflicts any kind of bodily injury to a person JCAS cannot intake and adopt that animal out again. I understand that if this does occur and I can no longer keep the animal, I will be required to contact my Veterinarian, local animal rescues, and training facilities to find a solution and/or placement for this animal. If veterinary treatment is unavailable and/or placement cannot be found, I understand that with the proper documentation of attempts and/or Veterinary recommendation I may return the animal to JCAS and the animal will be Humanely Euthanized. A Euthanasia fee of $125.00 will be due at the time of surrender. *

Signature *