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808 Zorn Road, Bainbridge, GA 39817
(229) 246-0101
[email protected]
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Need Assistance with a Stray Animal?
Please Contact Animal Control at 229-515-0172.
Pet Adoption Application
Name
(Required)
First
Last
Email
(Required)
Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
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Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Home Phone
(Required)
Work Phone
(Required)
Which animal(s) are you interested in?
(Required)
Please indicate why you are interested in adopting an animal
(Required)
Companion for Other Pet
Family Pet
Child's Pet
Companion for Self
Mouser
Other
Will anyone in your household be surprised by the adoption of this animal?
(Required)
Yes
No
If yes, who will it be and why?
How many adults live in the household?
(Required)
Do any children live in your household?
(Required)
Yes
No
If yes, how many? Please list their ages
What pets do you currently have (please list pet's name and owner's name as listed at vet)?
(Required)
In addition to those listed above, what other pets have you had in the last five years? *
(Required)
Please describe what happened to each of those pets (put to sleep, run over, died of old age, given away, killed, etc., ...please be specific) *
(Required)
Have your current pets been spayed or neutered?
(Required)
Yes
No
N/A
Are your current pets up-to-date on their shots?
(Required)
Yes
No
N/A
Please list your veterinarians name and phone number
(Required)
What percentage of time will the animal live indoors?
(Required)
Do any of your current pets spend any time outdoors?
(Required)
Yes
No
N/A
If yes, please describe
(Required)
How much interaction will members of your household have with the animal? *
(Required)
Have you ever had problems with fleas or ticks?
(Required)
Yes
No
If yes, how did you handle it?
(Required)
Who will be primarily responsible for the daily care of this animal? *
(Required)
When home alone, where will the animal stay? *
(Required)
Garage
Basement
Run of the House
Outdoors
One Room of The House
Other
Where will the animal sleep at night? *
(Required)
Do you have a pet door?
(Required)
Yes
No
Have you ever given up a pet in the past?
(Required)
Yes
No
If yes, please describe.
If your animal develops chronic or serious medical problems, what will you do? *
(Required)
Where you live?
(Required)
Apartment
Condo
Townhouse
Mobile Home/Trailer
Single Family Home
Do You
(Required)
Own
Rent
Do you have a fenced yard?
(Required)
Yes
No
If no, how do you plan to contain the animal on your premise?
If you move, will your pets go with you?
(Required)
Yes
No
If no, please explain
Are you willing to allow a representative from Bainbridge-Decatur County Humane Society, Inc. visit your home by appointment?
(Required)
Yes
No
How did you hear about the Bainbridge Decatur Humane Society? *
(Required)
CAPTCHA
Consent
(Required)
I have adopted this pet from the Bainbridge-Decatur County Humane Society, Inc. Animal Shelter, to be a companion for me and my immediate family. If at any time in the future I find that I cannot keep (or choose not to keep) the animal, I agree to return it to the Bainbridge-Decatur County Humane Society, Inc Animal Shelter.
I understand that the Bainbridge-Decatur County Humane Society, Inc. Animal Shelter does not guarantee the health of any animal at the time of adoption or thereafter. Should my veterinarian find the animal to be unhealthy, it is agreed that I may return the animal to the Bainbridge-Decatur County Humane Society, Inc Animal Shelter within 15 days of adoption and exchange it for an animal with an equal adoption fee.
I promise, contract and agree to abide by my city, county, and state animal control ordinances and statutes, with regard to animal care, inoculations, custody, control and humane treatment. I agree to provide at least the minimum annual veterinary treatment recommended by my veterinarian. I understand that pursuant to State Law:
"4-14-3(2) Entering into a written agreement with the person acquiring such animal guaranteeing that sterilization will be performed by a licensed veterinarian within 30 days after acquisition of such animal in the case of an adult animal or within 30 days of the sexual maturity of the animal in the case of an immature animal;..."
This pet must be spayed or neutered within the time period stated by a licensed veterinarian.
I understand, contract and agree that the Bainbridge-Decatur County Humane Society, Inc. or the City of Bainbridge Animal Control Officer may examine and make inquiry about said animal at any time and if not satisfied with conditions may reclaim custody of said animal.
I understand, contract and agree that failure to comply with any of the above requirements to the satisfaction of the Bainbridge-Decatur County Humane Society, Inc Animal Shelter will void this adoption agreement and will also require me to return and release the animal to the Bainbridge-Decatur County Humane Society, Inc. Animal Shelter without charge or recourse of any character for licensing, fee, service fees, maintenance, care fees, or other.
I understand and agree that the Bainbridge-Decatur County Humane Society, Inc. Animal Shelter cannot and will not allow any refunds for adoption fees. The Bainbridge-Decatur County Humane Society, Inc., the City of Bainbridge, or its agent will not be responsible for any accident, injury or illness to any persons or animals resulting from an adopted Bainbridge-Decatur County Humane Society, Inc. animal.
I understand and consent to the release of the above information to Hill'S Pet Nutrition, Inc. for their exclusive use In providing adopters with product coupons and information.
I certify that I have read and understood the above and agree to abide by its contents
