BURLINGTON COUNTY ANIMAL ALLIANCE ADOPTION APPLICATION
NJ SPAY/NEUTER PROGRAM
Code RO23 DATE: ______
APPLICATION FOR (Name of Animal): ______
CONTACT PERSON: ______
NAME: ______
ADDRESS:______
______
HOME PHONE: ______ WORK PHONE: ______
LIST ALL FAMILY MEMBERS: (Spouse): ______
(Children’s names and ages): ______
______
______
LIST BELOW OTHER COMPANION ANIMALS THAT RESIDE WITH YOUR FAMILY:
Dog(Breed) or Cat Name Sex Age Spayed/Neutered (Y/N)
______
______
______
Your occupation______Name and address of present Employer ______# of years ______
DO YOU OWN ______YOUR HOME; OR RENT _____Landlord Name and Telephone # ______
______
IF THIS APPLICATION IS FOR A CAT, WILL YOU DECLAW? ______
WILL YOUR NEW COMPANION ANIMAL BE KEPT INDOORS, OUTDOORS OR BOTH? ______
DO YOU HAVE A FENCED IN YARD? ______IF NOT AND YOU ARE ADOPTING A DOG, WHERE WILL HE/SHE BE EXERCISED? ______
ARE YOU MAKING A LIFETIME COMMITMENT TO THIS ANIMAL? ______
Have you ever had to give up a dog/cat or release a pet to an animal shelter? If Yes, explain circumstance ______
HOW MUCH DO YOU THINK IT WILL COST TO FEED THIS ANIMAL PER WEEK? ______
HOW MUCH DO YOU THINK IT WILL COST FOR MEDICAL CARE PER YEAR? ______
ARE YOU GOING TO SPAY/NEUTER THIS ANIMAL? ______
IS ANYONE HOME DURING THE DAY? ______IF YES, WHO? ______
VETERINARIAN NAME AND PHONE NUMBER: ______
YOUR SIGNATURE: ______
BCAA REPRESENTATIVE ______
APPROVED: ______DISAPPROVED (Reason): _______
BURLINGTON COUNTY ANIMAL ALLIANCE ADOPTION AGREEMENT
NJ Spay/Neuter Program – Code RO23
This is an agreement for the adoption of ______(animal’s name) a ______(sex) ______(color/breed) feline/canine, born approximately ______between ______(Adopter) and BC Animal Alliance. Adoption donation is ______.
By signing this adoption agreement, I certify that I have read, understood and agree to the following conditions:
1. The Adopter agrees to take the animal to a veterinarian for an examination within seven (7) days after signing the contract and to hold BC Animal Alliance harmless for any defects the animal may now or later possess. If the Adopter returns the animal to BC Animal Alliance for medical reasons, there must be a note from a veterinarian stating the medical problem.
2. The Adopter accepts the responsibility for caring and providing for this animal’s welfare and agrees the animal will always receive quality food, water, shelter, companionship and veterinary care as needed and all vaccinations will be kept up to date. The Adopter agrees to comply with all state and local laws governing licensing and ownership of animals.
3. The Adopter agrees to have this animal altered at 6 months of age or by ______and supply written proof to BC Animal Alliance at the address below.
4. The Adopter agrees to maintain his/her cat as an indoor only cat and will not declaw the cat as this is considered mutilation and inhumane treatment.
5. The Adopter agrees his/her dog will be maintained as an indoor/outdoor dog provided that when it is outdoors, it has proper shelter from the elements (rain, sun, etc) and must be provided with fresh water at all times. Dogs must NOT be left outdoors for long periods of time in weather below 35 degrees or above 80 degrees.
6. The Adopter agrees to contact BC Animal Alliance in the event he/she can no longer keep this animal and that this dog/cat will NEVER be sold, leased, or given to any pet shop, animal shelter, research laboratory, or similar facility. The animal is NEVER to be transferred to another party without notifying BC Animal Alliance of the new owner’s name, address, telephone number and obtaining prior permission from BC Animal Alliance for the transfer.
7. The Adopter has been advised by BC Animal Alliance of any and all known adverse behavior problems and agrees to hold BC Animal Alliance harmless. The Adopter will be responsible for any damage or injury to persons or property that may be caused by the animal after he/she takes custody and possession of it.
8. The Adopter agrees to receive phone calls and/or visits from BC Animal Alliance to check on the adjustment and progress of the animal.
9. The Adopter agrees that if any of the above terms are not satisfactorily met, BC Animal Alliance may reclaim this animal without
refunding the adoption fee. The Adopter will be responsible for any medical or boarding fees incurred in readopting the respective
Animal.
10. Liquidated Damages: The adopter agrees to pay BC Animal Alliance $500.00 in the event that adopter breaches any terms in this
agreement which does not bar BCAA from seeking return of the animal by legal means.
11. The Adopter understands that the adoption donation is not a purchase price, but a contribution used to help other animals and is
therefore non-refundable.
YOUR SIGNATURE: ______TELEPHONE #: ______
ADDRESS: ______
VETERINARIAN NAME AND PHONE #: ______
BCAA REPRESENTATIVE: ______
944 Ohio Avenue, Trenton, NJ 08638
609-989-4830 or E-mail ; FAX : 609-989-0187