Dog/puppy Adoption Application (Page 3 of 3) in pdf

Dog/puppy Adoption Application Page 3

REFERENCES

One reference must be a veterinarian. Other references may include neighbors or co‐workers.

FOR EACH REFERENCE PLEASE LIST THE FOLLOWING: NAME/RELATIONSHIP/PHONE NO. (with

area code)

1) __________________________________________________________________

2) __________________________________________________________________

3) __________________________________________________________________

By signing below, I certify that the information I have given is true and that any misrepresentation of facts may result in my losing

the privilege of adopting a companion animal from the Rimrock Humane Society. This dog will reside in my home as a pet. I will

provide it with adequate food, water, shelter, training affection and medical care. I am in full agreement with these terms of

adoption. The Rimrock Humane Society is in no way liable or responsible for any damage, accident or injury resulting from the

placement of a dog in my household.

Signature________________________________________Date________________

The Rimrock Humane Society reserves the right to refuse any applicant!

Dog/puppy Adoption Application Page 3