RILEY COUNTY HUMANE SOCIETY, INC.

ADOPTION CONTRACT

P.O. Box 1202, Manhattan, Kansas 66505

Phone: 785-776-8433 Website: humane.manhattanks.org

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To apply for the adoption of an animal, please print this application, complete, and sign. You will need to give an original copy to the RCHS Volunteer that you have been meeting with.

Name of Adopter _________________________________________________________

Address of Adopter________________________________________________________

City/State/Zip_____________________________________________________________

Home Phone _____________ Work Phone _____________ Cell Phone ____________

Email Address ______________________

Driver’s Lic# & State______________________

Employer ________________________________________________________________

Landlord Name (if renting) _______________________

LL’s Phone no: _____________

Veterinarian’s Name _____________________________

Vet’s Phone no: ______________

Type of Animal (Dog/Cat/Bird)________________________________________________

Name of Pet to be Adopted _____________________________Sex ______ Age ______

References (at least one is required):

___________________________________ Phone ____________________

____________________________________Phone_____________________

____________________________________Phone_____________________

AS THE ADOPTING PARTY I AGREE TO THE FOLLOWING PROVISIONS:

1. I agree to keep an ID on the adopted animal at all times, whether inside or outside of the house, and to obtain all of the necessary licenses required by local authorities.
2. I agree to provide the adopted pet with necessary inoculations/heartworm treatments at the intervals advised by my veterinarian.
3. I agree to have the adopted pet under my control when it is not on the confines of my property. A secured fenced area will be provided for dogs, including shelter from the elements. If the adopted pet is a cat, I agree to keep the cat as an indoor- only pet. The adopted pet will not be tied or chained. I agree to provide nutritious food and a continuous supply of clean water.
4. If, for any reason, I cannot keep the adopted pet, I agree to notify the Riley County Humane Society (RCHS) at the above address and phone number, and return the adopted animal to an active member of the organization.
5. I understand that any failure to perform the foregoing agreement will constitute a breach of contract. In the event of a breach in contract, I authorize the Riley County Humane Society to reclaim both possession and ownership of the pet.
6. I understand that the pet covered by these adoption papers, is, as far as can be determined by the RCHS, in good health, and that the RCHS is not responsible for any medical fees incurred after the adoption date. However, if a health problem develops during the first 10 days, I should notify the RCHS to discuss the matter.
7. I give the RCHS visitation rights to ensure that the terms of this adoption agreement are being observed.

SIGNATURE OF ADOPTER: __________________________DATE:_______

RCHS Representative: _______________________________________________