Step 1 of 4 25% Animal Care Society Adoption Waiver of Liability and Assumption of Risk You are waiving legal rights – please read carefully! This waiver is executed on the date written below by the undersigned for themselves and/or as the lawful parent or guardian of a minor (collectively the “Visitor”) Visitor has been granted access to the facilities of the Animal Care Society located at 12207 Westport Rd. Louisville, KY. 40245 or a remote event site and is subject to the following specific requirements: Under no circumstances is the Visitor to put his/her fingers in any animal cage. Under no circumstances are minor children to be left unattended/unsupervised. Under no circumstances is a Visitor to open any of the animal cages. Under no circumstances is the Visitor to enter any area where animals are quarantined or designated staff only areas. The Visitor assumes full responsibility for any risk, injuries, and/or damages that the Visitor may incur while on the premises or while attending an offsite event. The Visitor voluntarily accepts and assumes the risks of being on the premises or attending an offsite Animal Care Society event knowing that animals are capable of causing serious injury. Visitor understands that all applications are subject to be reviewed by the Animal Care Society and completion does not guarantee an adoption. I hereby release and hold harmless Animal Care Society and its directors, officers, volunteers, agents, servants and employees, or any person affiliated with Animal Care Society with regard to responsibility for any for any and all risks, injuries, and damages resulting from or related to the Visitor’s presence at Animal Care Society or while attending an offsite event. Visitor understands and agrees to all of the terms in this Waiver of Liability and Assumption of Risk. Date(Required) MM slash DD slash YYYY Printed Name(Required)Print Name of Minor(s) if applicable. Write N/A if not applicable.(Required) I am filling out this adoption application in hopes of adopting:(Required)I am filling out this adoption application in hopes of adopting:a dog/puppya cat/kittenbothAnimal Name(Required)Match Maker ProfileName(Required)DOB(Required) MM slash DD slash YYYY Address(Required) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email(Required) Cell Phone(Required)Driver's License Number(Required)Secondary PhoneEmergency contact for microchip. (Someone other than yourself.)Name(Required)Phone Number(Required)Have you ever surrendered a personal pet to this or any other shelter/rescue?(Required) Yes No If so, what was the reason?(Required)What would be a reason you would return or rehome an animal?(Required)Examples: medical/behavioral/not acclimating well to an environment/etc.Why do you want to adopt?(Required) Companionship for myself/Family Friend for current pets Outdoor Dog/Cat Protection Adopting for children Other Select AllOtherDo you own or rent your home?(Required)If renting, please list landlord or apartment complex and phone numberYour household consists of:(Required) Adults Only I Live Alone Family w/ Children Where will this pet be kept at night?(Required) Indoors Outdoors Both Please list who lives in your home.Name of PersonRelation to AdopterAge Add RemoveDo you have any current pets? Yes, I have other pets. This is my first pet. ListNameBreed/AgeSpayed/Neutered?What vet do you take your current pets to? Add Remove DOG SPECIFIC QUESTIONSWhere will this pet be kept when the adopter is away from the home?(Required) Crate Loose within entire residence Barn/Garage Backyard Outdoor Kennel Confined space in home Select AllWhat kind of outdoor space can you provide your new potential pet?(Required) Fenced yard Patio Dog Park Daily Walks Indoor puppy pads Is it important for your new dog to be dog friendly? (Able to go to dog parks, dog bars, walks in high traffic areas, etc.)(Required) Yes No What level of obedience do you want your new pet to have?(Required) Puppy/No Training Basic Commands (Sit, Shake, etc.) Professionally Trained If the pet does not meet your training expectations, what methods are you willing to try?(Required) Professional Trainer Self Training Unable to provide any training Is it important that your new dog be social with people outside of the home? (Social gatherings, high traffic areas, interact with strangers, etc.)(Required) Yes No What energy level are you searching for in your new pet?(Required) Low Energy Medium Energy High Energy In a typical day, What is the average amount of time you are away from the home?(Required) 2-4 hours 4-6 hours 6-8 hours 8-10 hours CAT SPECIFIC QUESTIONSDo you plan on declawing?(Required) Yes No Unsure/Open to alternatives What kind of personality do you want in your new pet?(Required) Couch potato Independent Affectionate Playful Vocal Mischevious CAPTCHA Stay in touch with us! Sign up today to stay in the know about events, adoptable pets, ACS needs, and more! Submit your email…(Required) CAPTCHA
