MASSAS CREEK COMPANION ANIMALS

100 MASSAS CREEK ROAD

HERMANN, MO65041

Phone:636.488.5915

Fax: 636.488.5703

E-Mail:

ADOPTION APPLICATION AND AGREEMENT

APPLICATION MUST BE SUBMITTED AND APPROVED BEFORE

ANY ANIMAL CAN BE ADOPTED

PERSONAL INFORMATION

NAME
ADDRESS
HOME PHONE
CELL PHONE
E-MAIL ADDRESS
EMPLOYER ADDRESS AND PHONE NUMBER

TYPE OF RESIDENCE

TYPE OF RESIDENCE
OWN OR RENT? / HOUSE APARTMENT MOBILE DUPLEX OTHER
IF YOU RENT WE REQUIRE LANDLORDS NAME, PHONE NUMBER AND WRITTEN PERMISSION
CHILDREN IN THE HOME?
HOW MANY AND AGES?
ANY PET ALLERGIES?
OTHER PETS IN THE HOME? HOW MANY, WHAT AGES, BREED, GENDER, SPAYED OR NEUTERED?

VETERINARIAN INFORMATION

VETERNINARIAN NAME, ADDRESS AND PHONE NUMBER

PERSONAL REFERENCES

(WE REQUIRE TWO)

NAME, ADDRESS, AND PHONE NUMBER
NAME, ADDRESS, AND PHONE NUMBER

CARE AND RESPONSIBLE PET GUARDIANSHIP

HAVE YOU EVER OWNED PETS IN THE PAST? IF YES WHAT KIND AND HOW MANY?
IF YOU NO LONGER HAVE THESE PETS, WHAT HAPPENED TO THEM?
HAVE YOU EVER GIVEN A PET UP? IF YES, WHY AND TO WHOM DID YOU SURRENDER THE PET?
HAVE ANY OF YOUR PETS BEEN LOST OR HIT BY A CAR?
WHERE WILL YOUR PET BE KEPT WHEN YOU ARE AT HOME AND WHEN YOU ARE NOT AT HOME?
HOW LONG WILL YOU PET BE LEFT ALONE?
DO YOU HAVE A COMPLETELY FENCED YARD? SECURE OUTDOOR KENNEL? INVISIBLE FENCE? (PLEASE DESCRIBE)
HAVE YOU EVER HOUSEBROKEN A DOG BEFORE? IF NO PLEASE ASK US FOR INFORMATION
HOW WILL YOU DEAL WITH CHEWING ACCIDENTS?
WILL YOU ALLOW YOUR PET TO RIDE IN THE BACK OF A PICK UP?
DO YOU PLAN ON TAKING OBEDIENCE CLASSES?
WHAT WILL YOU DO WITH YOUR PET IF YOU HAVE A CHANGE IN LIFESTLYE (DIVORCE, MOVE TO A NEW LOCATION, HAVE A CHILD, ETC)?
ARE YOU AWARE THAT YOUR PET COULD LIVE FOR 12-20 YEARS?
HAVE YOU THOUGHT ABOUT WHAT YOU MIGHT DO IF YOU ARE UNABLE TO CARE FOR YOUR PET?
WHAT WILL YOU DO WITH YOUR PET WHEN YOU GO AWAY FOR AN EXTENDED PERIOD?

Dog Adoption Package Includes:

  • Microchip
  • Spay/Neuter
  • RV
  • First DHPPC
    Bordetella
  • Heartworm Test
  • Fecal
  • Rabies
  • It is the owners’ responsibility for all other vaccinations and medical care.

Feline Adoption Package Includes:

  • Microchip
  • Spay/Neuter
  • RV
  • First FVRCK
  • Felk
  • Fecal
  • It is the owners’ responsibility for all other vaccinations and medical care.

Spays and Neuters on puppies and kittens

will only be paid if performed at our veterinary providers.

MASSAS CREEK ADOPTION AGREEMENT

I understand that this is a legal and binding contract and agree to abide by all statements. If I do not, I understand that my pet must be returned to Massas Creek Companion Animals. I understand that that this contract is needed for and in the best interest and safety of said pet.

Pet adopted______Date______

i agree to care for this pet in a humane manner and be a responsible pet owner by supplying adequate food, water, shelter, MEDICAL CARE AND companionship ______.

i understand that this pet will require a period of time to acclimate to its new environment and accept full responsibility for training and will contact massas creel for training advice or any other pet care advice if needed _____.

i agree to place this pet under veterinary careAND WILL PLACEthis pet on a regular life long schedule of vaccinations and heartworm preventative______.

i understand thatALL ADOPTION APPLICATIONS MUST BE SUBMITTED AND APPROVED BY THE DIRECTOR OF THE SHELTER OR DESIGNATED RESUCE AGENT BEFORE A PET CAN BE ADOPTED. mccA reserves the right; at it’s sole discretion, not to make a pet available for adoption to anyone, for any reason._____.

i understand that massas creek cannot guarantee the health or longevity of a pet once it leaves the facility and that we do not make any claims or representations as to the behavior or temperament of the animal being adopted_____.

I understand that MCCA will only pay for spay/neuter on puppies and kittens if performed at the shelter provider veterinarian____

i understand an adoption fee will be collected for this pet : ______$150 DOG_____$100CAT.

i understand that if for any reason the adoption is not satisfactory, the animal must be returned to massas creek companion animals AND MY MONEY WILL BE REFUNDED_____.

I have read and understand this adoption agreement with the rescue agent. I have discussed this agreement with the rescue agent and have had all of my questions answered.

signature of adopter______

signature of co-adopter (if any)______

date:______

signature of rescue agent______

MCCA FOLLOW UP ON PET ADOPTION

SOMEONE FROM MCCA WILL CONTACT YOU REGARDING YOUR ADOPTED PET IN ONE DAY AND AGAIN IN ONE WEEK AND TWO WEEKS FOLLOWING YOUR ADOPTION. THIS IS BEING DONE TO INSURE YOU ARE HAPPY WITH YOUR CHOICE IN PET AND TO BE A RESOURCE FOR INFORMATION REGARDING YOUR PET.

WHEN WE CALL, PLEASE FEEL FREE TO ASK ANY QUESTIONS REGARDING PET CARE OR TRAINING. WE ARE HERE TO HELP YOU CARE FOR YOUR PET AND TO ENSURE THAT OUR PETS HAVE A PERMANENT PLACE IN YOUR HEART AND HOME.

WE WILL MAIL YOU A COPY OF YOUR ADOPTION PAPERS IF YOU ADOPT YOUR PET AT A LOCATION OTHER THAN THE MCCA SHELTER.