PO Box 1855

Cumberland, MD 21502

ADOPTION APPLICATION AND AGREEMENT

The recipient agrees to abide by all county and state animal control laws. The recipient agrees to accept this animal as a pet and companion. To ensure proper care and treatment for the animal in our charge, we reserve the right to reclaim the animal if it is not being cared for in a manner acceptable to us, or found to be in violation of county or state animal control laws.

The animal may have traits, health, or temperament issues unknown to us; the animal may become ill, and may bite. Heart of the Earth Sanctuary and Rescue will assume no liability as to the health or temperament of this animal. You will be provided with Vet records and will be made aware of any illness or challenges while in our care.

We try our best to vet all animals before adoption, have them altered and up to date on all vaccines. However, if not, the animal MUST be taken to your personal vet, or you may call The Stepping Stones Animal Society (a low cost clinic) at 12510 Naves Cross Rd NE, Cumberland, Maryland 21502, no more than (14) days after its adoption to ensure present and future health. Well check and rabies vaccination must be completed and returned to the rescue ______. The animal must be altered, if not done so already, by ______. Failure to comply with this may result in repossession of the animal by the Heart of the Earth Sanctuary and Rescue without refund of adoption fees.

All animals must be micro chipped within two weeks of adoption by The Stepping Stones Animal Society. Appointments can be made by calling 240-362-7547 and walk ins are accepted.

The animal, if feline, must not be declawed or have a Tendonectomyfor any purposes.

The animal must not be forced to live outside, for any reason. We will only adopt our animals out to homes where the adoptees agree that the animalwill live inside with their new family. We will not adopt to anyone if it is their intention to separate the animal from a life that it has become accustomed to.

I, the undersigned, hereby declare that I am aware:

  • That animals are different from humans in their response to human actions.
  • That the actions of animals are often unpredictable.
  • That animals should be closely supervised when they are with children.
  • The Heart of the Earth Sanctuary and Rescue makes no claims or representations as to the temperament, health, or mental disposition of the animal put up for adoption.
  • If it is found that the animal is living outside, it can be reclaimed by Heart of the Earth Sanctuary and Rescue without refund of adoption fees.
  • A copy of this agreement will be sent to my Vet. And that Heart of the Earth Sanctuary and Rescue has the right to call my vet at any time and check on the wellbeing of the animal.
  • That should I need to rehome the animal, I must return it to the Heart of the Earth Sanctuary and Rescue without refund of adoption fees.
  • I understand that Heart of the Earth Sanctuary and Rescue is able to do a home check.

I hereby accept the possession and title of the animal identified below and hereby release and waive any right against the Heart of the Earth Sanctuary and Rescue which I may have now or in the future for damages to person or property caused by said animal.

Adopter:______ID:______

Co-adopter:______ID:______

Address: ______

Home Phone:______Cell/Other Phone:______

Email Address: ______

Do you: ___ Own ___ Rent Landlord’s Name:______

Landlord’s Phone: ______Signed letter of permission from Landlord: ___ Yes ___ No

In my household there are (#): _____ other animals _____ children under 18 _____other adults

Veterinarian’s Name: ______Veterinarian’s Phone: ______

List the TYPE (dog, cat, etc.), NAME, AGE, GENDER, and SPAY/NEUTER status of all animals you currently own:

______

______

______

Information on animal you wish to adopt

Animal’s name: ______

Type (e.g. cat): ______Breed (e.g. domestic short-haired):______

Color:______Gender ______Age ______

Adoption Fee $______Cash ______Check ______

Heart of the Earth Sanctuary and Rescue reserves the right to contact landlords, veterinarians, or any other parties included or referenced in this application for verification purposes. Heart of the Earth Sanctuary and Rescue reserves the right to decline any adoption at any time. Any fraudulent information provided could result in an adoption being rescinded and the animal removed from applicant's home without a refund of adoption fees.

By signing this document, you affirm you are of legal age to enter into legal contract in the State of West Virginia, and that neither you nor anyone in your household has been convicted of cruelty or neglect on human or animal.

Adopter: ______Date: ______

Co-Adopter: ______Date: ______

Heart of the Earth Witness: ______Date: ______