Step 1 of 5 20% 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/kittenbothI'm interested in the animal named… Name(Required) Preferred Phone Number(Required)Address(Required)City, State, Zipcode(Required) Email(Required) Other Phone NumberDriver's License(Required) Date of Birth(Required) MM slash DD slash YYYY Emergency Contact – 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 yes, please explain(Required) Why do you want a adopt? (Please select all that apply)(Required) Companion for myself/family Breeding Adopting for myself Companionship for my current pets Mouser Adopting for Children Protection He/She will be a gift Adopting for my business Your household consists of(Required) Adults Only Lives Alone Family with children Parsons(Required)Name of PersonRelationship to PersonAge Add RemoveThe activity level in your home is:(Required) Quiet Active Very active Tell us about your housing situation:(Required) Own Home Own Condo Rent Apartment Rental House Live w/ Parents/Relative Mobile Home Are parents/relative aware you are interested in adopting a pet?(Required) Yes No If renting, please provide Apartment Complex Name/Landlord’s name & phone number: Complex Name/Landlord’s name(Required) Phone(Required) This pet will primarily be:(Required) Indoors only Indoors and Outdoors Outdoor only Where will this pet be kept when away from the home:(Required) Garage Basement Restricted to one Room Crate Loose within Residence In Fenced Yard Staked/Chained in Yard Outside Kennel Small blocked off area of Home Do you have a fully fenced yard?(Required) Yes No If yes, what is the height & material of your fence (4ft chain link, 6ft privacy, invisible)(Required) If adopting a dog, are there any other dogs (other than your own) that this dog must get along with? (relative's dog, dog sitter's dog, neighbor's dog, etc.)(Required) Yes No What training methods will you use to handle potential problems like barking, chewing, scratching, housebreaking, going outside litter box, etc.?(Required) Do you have any current or previous pets ? Yes, I have/had I do not currently have any pets. I do not currently have any pets/have not owned any in the past 10 years. Please list all your current and previous pets (For the past 10 years).(Required)Pet NameSpeciesSexAgeAltered?Indoor, Outdoors or BothVaccines Current?Years OwnedCurrent or previous? If previous, why do you no longer own? MaleFemaleYesNoIndoorOutdoorsBothYesNo Add RemoveWhat veterinarian clinic currently sees or did see you previous pets? (Name & Phone # )(Required) Please describe what personality of pet are you looking for? (energetic, couch potato, loving, etc.)(Required)CAPTCHA Δ 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 Δ
