“GEPDA ADOPTION FORM”

“Group Education to Protect and Defend Animals”

Jillian Broughton, Adoption Coordinator,

408-460-0334, Campbell, CA

Pet Name / Description
We are committed to placing pets in the best possible homes. Please provide the following information to assist the pet's current guardian.
Adopter's First Name / Last Name
Address / City Zip
Phone / Cell Ph. *
Email /
I currently live in a House Condo Apartment Townhouse
How long at this address?
Are there screens on the windows and doors? Yes No
If renting, are pets allowed? Yes No
Number and ages of children living at home
Have you ever surrendered a pet to a shelter/pound? Yes No
If yes, describe circumstances

Have you ever owned a pet before? Yes No
What type of pet did you have?
What happened to the pet?

Are your pets altered? Yes No
Are your pets current with vaccines? Yes No
May we call your vet as a reference? Yes No
If yes, who is your vet (name, address, ph no.)?

Have you ever cared for a sick animal? Yes No
Describe

My new pet will be Indoors Outdoors Both Please explain ______
Where will your new pet live/sleep?
If cat, have you ever had a cat declawed? Yes No
Do you plan to declaw this new cat? Yes No
What will you do with your pet if you have to move several times
in its lifetime and expense becomes a factor?

What will you do with your pet if you or someone develops allergies?

What will you do with your pet if you or your spouse becomes pregnant several times and expense becomes a factor?

ACKNOWLEDGEMENTS
I agree and understand that this animal is being offered for adoption by the pets current guardian as part of GEPDA’S Adoption Program. GEPDA will take back all pets that were adopted from a GEPDA Representative, if animals do not work out, but all fees are non-refundable and are used for donations to GEPDA. GEPDA cannot be responsible for property damage, injury or illness caused by interaction to your pets and the owners will be responsible for all vet bills.
(initial)
I agree and understand that GEPDA makes no representations regarding the truth and accuracy of any statements contained in this pet's biography. The pets' current guardian provides all representations contained therein.
(initial)
I agree and understand that I am completely responsible for the care and treatment of this animal once I adopt this animal from its guardian until it dies from old age.
(initial)
I agree and understand that GEPDA is not responsible for the care or treatment of this animal, nor any veterinarian bills this animal may have or will incur.
(initial)

GEPDA prescreens all animals and will not knowingly provide an animal that is dangerous or unsuitable for adoption. If for any reason, you can no longer take care of this pet, you must submit it back to GEPDA at ANY time and at ANY age. This pet WILL go back to us and is not to be advertised or given to any other party but GEPDA. The pet must be returned to GEPDA, if pet doesn’t work out. I______

will care for, protect and provide for this animal (s) in an appropriate and loving manner to the very best of my abilities for as long as it lives.I will provide vet care for all illness and “shots” upkeep and keep ID tags on this pet at all times with current information, and micro-chip. We promise to have 1 vet check within 2 weeks after arrival for pet’s check up. GEPDA has the right to follow up with vet and if ID is still prevalent on the pet. We have the right to take back any pet, if contract is not being kept and funds are kept as a donation to GEPDA.

Donation in check/cash is due at time of approving your pet adoption.Remember you are saving a life and giving it a warm and happy home, that has seen the worst and deserves the best! Our animals come from Rescue Reports, Hurricane victimsand the KernCounty Shelter.

Any questions, please contact GEPDA “Group Education to Protect and DefendAnimals”,GEPDA ADOPTION COORDINATOR, JILLIAN BROUGHTON ather e-mail or (408) 460-0334 who believes in giving “Fur Babies” another chance.

Thank you for wanting to save a life,

Jillian Broughton

GEPDA Treasurer/GEPDA AdoptionUSA Coordinator

408-460-0334, Campbell, CA