Adoption Agreement/Contract

Step 1 of 5 – Personal Information

Personal Information

Name(Required)

First Last

Date(Required)

Email(Required)

Address(Required)

Street Address City State ZIP Code

Home Phone(Required)

Cell Phone(Required)

Date of Birth(Required)

Drivers’ License No.

Occupation/ Employer(Required)

Name, Address, Phone Number and length of employment

Emergency Name and Contact Number(Required)

Agreement

I 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)

Name

This field is for validation purposes and should be left unchanged.