Name
*
First Name
Last Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Email
*
Dog's Name
*
Who lives in the home?
*
Please list all family members, roommates etc.
Do you Own or Rent your home?
*
Own
Rent
Do you have a fenced in yard?
*
Yes
No
Are there any other animals in the home?
*
Yes
No
Adoption Agreement
I am adopting the animal for myself, and I agree to not give away, sell, or trade my animal, even as a gift to a family member or friend without Noah's Haven prior approval.
I will neither take the animal to a shelter, nor abandon the animal. I will care for this animal in a humane and responsible manner. I will provide it with clean and appropriate shelter, food, water, exercise, companionship and veterinary care. This animal will be indoors and will not be chained/penned outside.
I understand that Noah's Haven recommends that I have a veterinarian examine this animal within 5 days of adoption. I can return the animal to Noah's Haven within 5 days of the date of the agreement and Noah's Haven will refund half of the adoption fee paid. The adoption fee is not refundable after 5 days from the date of the agreement, even if the animal is returned to Noah's Haven.
At the time of the adoption, the animal will have age appropriate core vaccinations unless an Noah's Haven veterinarian recommends delaying and vaccinations for health reasons. If vaccinations were not completed and were due prior to adoption, $200 will be discounted from the adoption fee to go towards those fees.
I agree that I, as the adopter, am financially responsible for the animal (including boosters and subsequent vaccinations) effective the date of this document. A representative from the organization may make inquiries to veterinarians or visit the animal to ensure that it is well taken care of.
If we find that the animal has been neglected or abused in any way or for any reason, we reserve the right to remove the animal from the premises. Attempts to remove the animal shall not constitute trespass at the property occupied by the animal. Upon removal, ownership rights of the animal automatically transfer back to Noah's Haven.
In the event the animal becomes lost, stolen, or dies, I will immediately contact Noah's Haven.
I agree that in the event that I need to leave town or vacation, I will reach out to Noah's Haven for boarding options.
I will notify Noah's Haven of any change of contact information (address, phone, or email address)
I will notify Noah's Haven, without delay, if I can no longer care for or keep my animal and agree to give Noah's Haven reasonable time to re-home my animal or place my animal in an approved foster home, if available. I agree that I will ensure the animal is up to date on vaccines and notify Noah's Haven of any behavioral problems that have occurred before I return my animal.
HOLD HARMLESS/INDEMNIFICATION: If animal's known background and medical history have been discussed with me, I understand that Noah's Haven has made no representation concerning the health, condition, training, behavior, or temperament of the animal. Noah's Haven found/owner, volunteers, and/or agents shall not be liable to adopter on any theory of legal liability. Including but not limited to: the negligence of Noah's Haven (and its Officers, Volunteers and/or agents) for any injury, death or damage directly or indirectly caused by this animal. Adopter does hereby release Noah's Haven (and its Officers, Board of
Directors, Volunteers and/or agents) from any and all liability, claims, suits, obligations, demands or causes of action, known or unknown, foreseen or unforeseen, arising out of or relating in any way to this animal or Noah's Haven's release of this animal.
At Noah's Haven's discretion, we may approve a foster-to-adopt arrangement. An adoption is not final until confirmation is received in written form from Noah's Haven. At Noah's Haven's discretion, we may approve an adoption prior to the spay/neuter of an animal, and a Spay/Neuter Agreement will be required. I agree to be bound by the terms of the separate Spay/Neuter Agreement.
I agree that Noahs Haven will remain as a secondary contact on this animal’s microchip registration with the phone number (971)237-5544. I will ensure proper licensing of the animal and compliance with all applicable local and state statutes.
I agree that any and all formal training will be done by Noah's Haven or cleared with written consent to go elsewhere for training.
I agree that at no point and time I will take the rescue animal to a dog park or any off
leash dog park like facility.
I authorize Noahs Haven to contact my veterinarian(s) to check the care provided to previously and/or current pets, and to check the spay/neuter history; My landlord to ensure that I have his/her/its permission to keep pets) on the premises; and My employer to confirm employment.
I certify that all the statements made by me on the Adoption Application are true and correct.
I agree that Noah's Haven has the right to confiscate the adopted animal in the event that any statements made by me are found to be false and/or payment for the adoption fee is returned or denied.
I UNDERSTAND THAT FAILURE TO COMPLY WITH ANY OF THE ABOVE PROVISIONS MAY RESULT IN FORFEITURE OF THE ANIMAL TO NOAH'S HAVEN.
Terms and Conditions
*
By Checking this box I agree that I have completely read and understand the information set above by Noah's Haven for adoption.
Date
*
MM
DD
YYYY