Alna Animal Shelter
21 Ames Road
Alna, Me 04535
207-882-7421 or Fax 207-882-6760
Date______
DEPOSIT CONTRACT on Purchase of Animal
Cat KittenBirdShelter Animal ID # ______of Animal
Puppy D.O.B. / / Adult Dogs AgeorD.O.B. / /
Is the animal here with in N/S Yes No if No will you agree to have N/S Yes or No
There will be a deposit for the insurance that you will follow through, having N/S By said date / / for your refund to be issued back to you, fax or send via snail mail us a copy of the certificate to receive such refund of $______
Coat Color Blk /Wht Red /Wht Gry/Wht Other _____
Animals [Right eye color Blue Brown ] [Left eye Blue Brown] Male Female
Does animal have special needs: Yes No
Tattoo Number______or Microchip number ______
Pure breed Yes No AKC Registered animal Yes No
$ ______Adoption Price Of Animal
$ ______Neuter / Spay Deposit will be refunded when a copy of certificate is faxed or mailed we then will issue a check this is to be done by______or no refund will be given unless said by the veterinarian that it should not of been done for reason must be in writing to us by the attending veterinarian.
$ 40.00 Microchip with pre paid registration
______Subtotal
______- Less Deposit
______Balance due at time of pick up
**Final payment must be made either by cash money order **
Personal checks will be accepted as final payment, but only after the check has cleared will you be able to pick up your Adopted animal. Thank you for your understanding in this matter. I have read or have had read to me the above contract and the health guarantee and I understand and agree to the terms of both of these documents.
Adoptee Signature______
Print Name______S.S. Number For your personal
Address______
Phone# ______
Signature of Shelter ______
Print Name______
Cat KittenBirdShelter Animal ID # ______of Animal
Puppy D.O.B. / / Adult Dogs AgeorD.O.B. / /
Is the animal here with in N/S Yes No if No will you agree to have N/S Yes or No There will be a deposit for the insurance that you will follow through, having N/S By said date / / for your refund to be issued back to you, fax or send via snail mail us a copy of the certificate to receive such refund of $______
Coat Color Blk /Wht Red /Wht Gry/Wht Other _____
Animals [Right eye color Blue Brown ] [Left eye Blue Brown] Male Female
Does animal have special needs: Yes No
Tattoo Number______or Microchip number ______
Pure breed Yes No AKC Registered animal Yes No Questionnaire Age Group 20 30 40 50 60 other
When some one wants an Animal from us we require you to answer the complete packet we care where are animals go please answer all questions So we can determine if you would make a suitable pet owner for said animal, also determine if this Pet is right for you!
Buyers Name ______Sex M F
Mailing Address______City /Town ______State____ Zip ______Physical Residence if not same as mailing address______State____ Zip ______Email Address______Tel Number______
Circle and or fill in spaces below please
Are you married Yes No
Are you Employed Yes or No
Where Please give your Place of employment
Company Name ______Address______Telephone number______ext.______how long employed ______can we call there to verify Yes No if no why not ______then please show recent pay stub for verification wages, or salary aprox. ______
Will your spouse financially provide for this purchased animal? Yes No
Spouses Name ______
Do you Own or Rent where you are living ? If you Rent you will need to fill out a Landlord Permission form stating you can have pets where you are renting or leasing See form with in the adoption packet
How many years have you lived here at address above? Years Months Is this animal going to reside at address above Yes No if No where ______
What will and can you provide for this Animal while it lives with you?
Taking in a Animal is a life time commitment so are you and your family prepared for the whatever? Yes or No
Are you willing to do what it takes to care for such a pet provided there could be life altering situation(s)
Such as: We have to move (Get rid of pet) oh we don't have time anymore or the dog is jumping on the kids oh he’s nipping or biting at them. oh he has been so sick and we cant afford to pay medical bill so let put him down or got hit by a car and no money is worth spending on for his injuries. We are all faced with everyday challenges in our lives and its your responsibility to do what it takes to care for a pet and not just pass the responsibility on to someone else like putting the animal back into a animal shelter or having the animal euthanized So will and can you give to a animal what it takes Yes No
Please give us things you will or can do for this animal that you want to bring into your home
Will this animal be in a pen outdoors? Yes No
Is Pen up already? Yes No
On a Run or stake outdoors? Yes No
In the House Yes No Other______
Will you use a crate for this animal you are adopting Yes No
if Yes When______How long will it be left in crate ______
Do you have knowledge of crate training Yes No
How many hours will the animal be left alone ______
Say you discover that your pet has anxiety issues will you seek Doggie Daycare In the home or away from Yes No or take pet to work with you provided you have the type of job that allows you this freedom Yes No
Will you take pet to obedience’s school Yes No
Would you have a animal euthanized Yes or No
Please give comments you would like to add here in the best interest of the animal you want to adopt
Income verification
Persons Name providing for this animal financially______if other then buyers name above______
Is this animal going to be residing with someone different then the Adoptee Yes No if yes give persons person s name ______address ______Tele______Relationship to buyer______
Please circle which apply Is this animal a gift Surprise Other Explain why are you choosing this breed of animal for your pet? ______
What do you know about this breed you want adopt______
Do you have other animals Yes No? ______if yes please list them ______do you think your new pet will get along with the animals you now have? Yes No not sure
What will you do to see that they do get along if they seem to not be getting along with each other ______
Number of children that you have and their ages ______or that will be around the animal and their age’s ______or that will be living with this animal, please give the ages of the children ______Will the children help with this animal? Yes No
All of the questions you have answered on this form must be true if found out that they were answered false then animal may be subject to be asked that you must return
Approval status Landlord check Ok Yes No / Veterinarian Approved Yes No / Employment approved Yes No
Adoption Agreement of said Animal
Cat KittenBirdShelter Animal ID # ______of Animal
Puppy D.O.B. / / Adult Dogs AgeorD.O.B. / /
Is the animal here with in N/S Yes No if No will you agree to have N/S Yes or No There will be a deposit for the insurance that you will follow through, having N/S By said date / / for your refund to be issued back to you, fax or send via snail mail us a copy of the certificate to receive such refund of $______
Coat Color Blk /Wht Red /Wht Gry/Wht Other _____
Animals [Right eye color Blue Brown ] [Left eye Blue Brown] Male Female
Does animal have special needs: Yes No
Tattoo Number______or Microchip number ______
Pure breed Yes No AKC Registered animal Yes No
We at Alna Animal Shelter have the right to examine and make inquiry about the said animal in this contract at any time, and if we find that the animal is not in good living conditions and or in good health, and not up to date as far as the vaccinations as to the standards of the State of Maine Animal Welfare, we may demand the animal to be turned over to us upon demand.
What I will agree to as the Adoptee of said animal in this contract
I agree to provide proper water and adequate food, and kind treatment at all times, meeting with the approval of Alna Animal Shelter.
If for any reason I do not any longer desire to keep the said, animal in this contract I will not sell, give away, or abandon for any reason. I must inform Alna Animal Shelter before doing any of the above and return it to Alna Animal Shelter.
I will take said animal to a licensed veterinarian for a health check with in 24 hours of my adoption. I will continue a full veterinarian program to prevent and or cure illness.
I will obey local laws regarding, licensing and all animal control laws .
I agree and understand that this animal should be vaccinated against rabies
Feline’s 3-5months of age for canines 4- 6 Months of age
For other animal see what is appropriate for the species______
I agree to have this animal neutered or spayed by a licensed veterinarian of my choice, no longer then 6mths of age or as agreed upon with in this contract
Your Adoption price of said animal is only refundable if said animal is not in good health stated from licensed veterinarian with in 24 hours of the day you adopted it from the animal shelter You must have warranty validated at this time, if not validated from licensed veterinarian then this warranty is Null and void from further action being taken toward the animal shelter.
Alna Animal Shelter is in no way responsible for any damages in which your purchased animal may do to another person’s property, and no attempt will be made to hold the Alna Animal Shelter responsible.
I ______Understand that this agreement is a legal and binding Contract between Alna Animal Shelter. And myself the Adoptee.
Adoptee's Signature ______Date / /
Veterinarian Release of Pet Owners Information
I ______am Giving Alna Animal Shelter Potential Animal Adoptee's Signature
The right to contact my Veterinarian for medical information on my prior pets medical care we have or given to our pet (s) seen by veterinarian listed here Name of Pet ______Type of Pet Cat Dog Other
Name of Pet ______Type of Pet Cat Dog Other
Name of Pet ______Type of Pet Cat Dog Other
Name of Pet ______Type of Pet Cat Dog Other
Name of Hospital or Clinic your previous or past pets have / or are still being seen by ______
Address______Tel______
Veterinarian’s Name if known ______
To whom it concerns: Could you release in writing any and all pet care information pertaining to this Potential animal adoptee on the pets they have listed or pets in their file.
You may Mail or Fax back to us see heading above
This person (s) wants to purchase / adopt ______(Type of Animal wanting to adopt)
It is required we have documentation from adoptee's veterinarian before any animal may be considered adopted here from our facility.
1. Has this person within this release form properly caring for pets animals listed with in your clinic
2. Is the pet(s) up to date on vaccination Rabies Yes No Annual Boosters per species Yes No Lymes Yes No HTW Yes No Other
as well as given the medical attention to all animal (s) in your file or other animal (s) that you knew they owned Yes No Explain______
3. Would you care to add comments to this person(s) creditability to owning and caring for animals of any kind? We hope you do so below, it is for the best interest of the animal being adopted that we have asked you to answer this question. ______
X______Date / /
Veterinarian Signature or Office Secretary Signature authorized to complete this form
Feel free to contact us for any or all questions you may have concerning this matter and ask for Helen Webber
Thank you for taking the time in answering the questions and added information you have given us. It is helpful in our determining the placement of animals that want to be adopted from our facility.
Landlord Release of Information
Let me introduce myself, we are an Animal Shelter
We like to have the approval of landlords allowing the renter have animals within its building or single home that you rent to this person we are inquiring about.
Before we release animals to the potential purchaser or adoptee we must have your ok.
See below what the renter wants to adopt .
Animal ID # ______of AnimalMale Female
Puppy D.O.B. / / Adult Dogs AgeorD.O.B. / /
Does animal have special needs: Yes No
Tattoo Number______or Microchip number ______
I ______Give Alna Animal Shelter.
Potential Animal Buyer’s Signature
the right to contact my Landlord for information on weather or not I can have animals with in this building I rent
Name of Landlord______Address______Telephone ______
To whom it concerns: Could you release in writing any and all information pertaining to this Potential animal adoptee on are they allowed to have animals or pets with in the building you own and rent to them.
You may Mail or Fax back to us see heading above
We must have your information before any animal leaves our facility in case this person should not have any other or more pets, simply due to not properly caring for the animal (s) they have or have owned in the past or still own.
1.Has this person within this release form properly keep its animal (s) on your property safe, clean or looked after that you are aware Yes No.
2.Does this person pay its rental fee on time Yes No
3.How long has this person rented from you? Months ______Years ______
4.How many animals have you known this person to have ______or had ______or that they still own______can you tell us what they are.______
5. What size lot or yard does this Renter have access to? ______
6.Is this building or single home on busy road that might not be considered safe for animals if they were to get loose or escape Yes No is there a fenced in area available or is the renter able to put one up if they do decide to have a animal such as a dog Yes or No
Would you care to add comments to this person(s) creditability to owning and caring for animals of any kind? We hope you do so below, it is for the best interest of other animals that we ask you to answer this question. ______
X______
Landlords or Office Secretary Signature authorized to complete this form
Feel free to contact us on any or all questions you may have concerning this mater
Thank you for taking the time in answering the questions and added information you have given us. It is helpful in our determining the placement of animals Adopted from our facility.