Adoption Agreement/Contract Please consider making a donation to Kerrville Pets Alive in lieu of your adoption fee. DONATE NOW Adoption Agreement/Contract Step 1 of 5 - Personal Information 20% Personal InformationName(Required) First Last Date(Required) Month Day Year Email(Required) Address(Required) Street Address City 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 State ZIP Code Home Phone(Required)Cell Phone(Required)Date of Birth(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Drivers’ License No. Occupation/ Employer(Required)Name, Address, Phone Number and length of employmentEmergency Name and Contact Number(Required) Household InformationDo you own or rent your home?(Required) Rent a House Rent an Apt Own a House Live with Parents or Other Relatives Please provide your landlord's name and phone number:(Required)Please give pet rules regarding the pets(Required)Is your yard fenced?(Required) Yes No Are there any slats/openings that could allow a small dog to get out?(Required) Yes No What type of fencing, what is the height?(Required)Name, Age, and Relationship of all persons living with you(Required)Is everyone in your home aware that you have applied to adopt?(Required) Yes No Is everyone in your home agreeable to having a new animal at home(Required) Yes No If no, please explain(Required) Animal Care InformationName, age, and breed of all animals living with you and are they up to date on shots(Required)How did you hear about KPA?(Required)Name of animal you are interested in adopting(Required)What do you like about the animal you chose(Required)Veterinarian Name and Phone Number(Required)May we contact your Veterinarian for a reference?(Required) Yes No Please contact your Vet and ask them to authorize the release of information to Kerr Pets Alive.Have you seen another Veterinarian?(Required) Yes No If so, please provide name and phone number.(Required)Where will your animal stay when you are at home?(Required)Where will your animal stay when you are away from home?(Required)How much time will your animal spend alone each day?(Required)Have you ever given up an animal?(Required) Yes No If so, what was the reason?(Required)What would make you return this animal?Do you understand that sometimes a complete history and temperament of a rescue animal may not be known?(Required) Yes No I only want to adopt an animal with a known history.(Required) Yes No Do you have any concerns about adopting?(Required) Yes No If so, please explain:(Required) ReferencesPlease list two personal references not living in the home that we may contact.(Required)Only one family member, please. AgreementI PROMISE TO NEVER ABANDON OR DISPOSE OF THIS PET. If I can no longer care for or keep this pet, I will return the pet to KPA.(Required)By submitting this application, I affirm that the facts set forth in it are true, correct, and complete to the best of my knowledge. I understand that any false statements, omissions, or other misrepresentations made by me on this application may result in an immediate termination of the adoption contract and the adoption animal to be returned. KPA shall be held harmless from and against any and all claims and damages of every kind, for injury to any person or persons and for damage to or loss of property, arising out of or attributed to, directly or indirectly, the operations or performance of the above named adopter under this agreement, including claims and damages arising in whole or part from the negligence of KPA. I agree to notify KPA of any injuries such as illness, escapes, injuries or any concerns pertaining to my adopted animal as soon as possible. I agree to the sterilization requirements set forth in the Texas Health and Safety Code Title 10 Chapter 828. I certify that the information on this application is true. I give permission for you to contact my landlord and veterinarian’s office as well as run a criminal background check on me. Please sign and enter today’s date. I agree Signature(Required)I certify that the information on this application is true. I give permission for you to contact my personal references, HOA, landlord, and veterinarian’s office. Please enter your name, and today's date:Date(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920NameThis field is for validation purposes and should be left unchanged.
