Sterilization of an Animal Adopted from a Public Or Private Animal Pound, Shelter, Or Humane

Sterilization of an Animal Adopted from a Public Or Private Animal Pound, Shelter, Or Humane

Sterilization of an animal adopted from a public or private animal pound, shelter, or humane organization is required under Chapter 828, Texas Health and Safety Code. A violation of this chapter is a criminal offense punishable as a Class C misdemeanor.

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CONDITIONS OF ADOPTION:

Animals are adopted to persons 18 years of age or older as household pets. The animals shall have adequate food, water and shelter at all times and veterinary care as required. Outside dogs are required to have a fenced yard.Chaining dogs is a criminal offense in violation of state law.

No adoptions will be made to renters in violation of lease or rental agreements.

Adopted animals shall not be traded, sold, or used in research. If you become unable to care for the pet, you agree to first ask HSHC if the animal can be accepted back into the HSHC program. If HSHC cannot accept the animal for any reason, you agree to inform HSHC of the placement of the animal.

If animals cannot be spayed or neutered, the adoption is conditional upon sterilization by a specified date. If this surgery does not occur, you agree by your signature below that you will return the animal to the HSHC and if not, that the Humane Society of Harrison County may enter your property and reclaim the animal.

REFUNDS: One-half of the fee may be refunded under the criteria below.

NO REFUNDS after 10 days, or on a pre-sterilized animal unless it is re-adopted. To receive a refund, you must bring all adoption papers back with the animal, including rabies certificate and tag if applicable..

No money paid by you for veterinarian care above the amount paid by HSHC is refundable. You should have your pet checked for intestinal parasites and heartworms at your expense. Animals are given an initial disease inoculation as soon as they are old enough but may not have full immunity. You must ensure additional inoculations as necessary.

By your signature hereon, you agree that here are no guarantees on the health or disposition of any animal adopted and that the Humane Society of Harrison County is not liable for any animal adopted, either as to the animal’s health, disposition, or any personal or property damage it may cause.

By your signature on page 2 below, you authorize the Human Society of Harrison County to verify all information given herein with your landlord, veterinarian, or any other party. A valid picture ID is necessary for your application to be approved.

NAME:______SPOUSE: ______

Address: ______

City______ZIP______Home Phone______

E-mail: ______Cell (alternate)Phone______

If you live in a rural area, what main highway, farm/market road or county road do

you live on? ______Please draw a map to your home on the back of this page.

Work Phone______Drivers License #______Age______

Employer______

Spouse Employer______

Do you live in a House_____ Apartment_____ Mobile Home______

Do you own ____ or rent______. If you rent does your lease allow pets? Yes__ No___

Owner of property:______Phone______

How many children live in your home? ______What are their ages?______

Have you ever owned a Dog and/or Cat before? Yes___ No____

Have you ever adopted a Dog and/or Cat before? If so, when? ______From

what agency or facility? ______

Do you have any Dogs or Cats now? Yes ___ No___ How many?______

(List all information as to each pet; use back of sheet if necessary.)

Spayed or neutered?

Breed: ______Age:______Sex: Yes No

Breed: ______Age:______Sex: Yes No

Breed: ______Age:______Sex: Yes No

Breed: ______Age:______Sex: Yes No

Current Pets: vaccinations current? ______Last date given: ______

Are the dogs on heartworm prevention? Yes___ No___ Type: ______

Do you have a fenced yard? ____ a dog pen? ____ Dimensions of pen______

If this is to be an outside pet, what protection from the weather will it have?

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If you wish to adopt a cat, do you prefer a declawed animal? ___ yes ___no

What veterinarian do you use?______

Phone______Address: ______

Where will this pet stay during the day?______At night?______

How many hours will this pet spend alone each day?______

Do you know how to crate train a Dog?______

How will you keep your pet confined to your property?______

Are you agreeable to the Humane Society making visits to observe how the new pet is doing? Yes___ No___

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Signature of ApplicantDate

HSHC REPRESENTATIVE MUST SIGN

Approved______Denied______Date______

1901 Jefferson Ave., Marshall, TX. Mail: P.O. Box 155, Marshall, TX 75671

903-938-7297