Animal Refuge Foundation of Wayne County
P.O. Box 432 ~ Jesup, GA 31598 ~ (912) 586-6198
Adoption Application and Indemnification Agreement
Applicant Name: ______________________________________ Telephone Number(s): __________________________
Address: _______________________________City:_____________________ State: ____________ Zip Code:________
Email: ________________________________________ Do you ____own or ______rent your home?
How long have you been at this address? _____ Previous address: ___________________________________________
Do you own animals now? ___yes ___no
If yes, how many and what kind? __________________________________
Name of Pet you wish to adopt: __________________________Approximate Age: _____Color: ________________
Breed: ____________________________ Sex: ____ Altered? ______
Name/location of your veterinarian____________________________________________________________________
Please provide two personal references:
1. ______________________________________________________________________________________________
Name
address
phone #
2. ______________________________________________________________________________________________
Name
address
phone #
The pet you are applying to adopt has been rescued. In consideration of the Animal Refuge
Foundation of Wayne County (ARF) allowing the applicant to adopt said animal as a pet, and other good and valuable
consideration, the receipt and sufficiency of which is hereby acknowledged, the applicant hereby agrees as follows:
1. ____To be solely responsible for the animal and to provide adequately for its care and well being, including but not
limited to the following: To properly feed, house, and water this animal, provide monthly heartworm preventative
for this animal, provide regular vaccinations, parasite checks, exercise, and companionship. Notify ARF
immediately if the animal is lost, stolen, or dies, and to make all reasonable efforts to find the animal if lost or
stolen.
2. ____To understand that the pet I am adopting has been rescued therefore no long standing history is available
prior to the pet being a foster rescue of ARF’s. ARF foster rescues receive quality standard veterinary care, and
seldom, but in some cases there is the possibility there may be an underlying health issue that goes undetected.
ARF assumes no liability for these type issues, as we supply any medical records & history that is available on the
foster rescue to the adoptive parent. ARF asks that the adoptive owner make compassionate, humane decision’s
for their pet’s healthcare, but understands that in some cases humane euthanasia may be the option that is
chosen. ARF will not hold any adoptive parent liable for humane decisions, especially those based on veterinary
recommendation. ARF only asks that pets be returned in the event they can simply no longer keep the pet, so that
ARF retains the re-homing process. Pets that may become ill due to the normal aging process or underlying issues
are the adoptive owner’s responsibility once ownership is assumed. ARF does not have the expectation that these
pets be returned, as they are not eligible for re-homing.
3. ____If unable to keep the animal or to satisfactorily re-home it, contact ARF. ARF will attempt to assist you in rehoming the animal and, in some cases, if a foster is available, can take the animal back. NEVER take the animal
to an animal shelter.
4. ____To indemnify, defend and hold harmless, and hereby covenants not to sue or pursue any similar action against
ARF or any of its members, volunteers, agents, and representatives (collectively, "releases") from any and all
claims, demands, liens, causes of action, suits, obligations, controversies, debts, costs, expenses, fees (including but
not limited to attorney's fees),damages, taxes, judgments, and orders of any kind or nature whatsoever, in law,
equity, or otherwise, whether known or unknown, anticipated or unanticipated, relating to this animal you are
adopting from ARF. Any breach of this agreement by the new owner(s), the new owner(s) interaction with any of
the releases, any of the releases' cage of this animal prior to the date of this adoption certificate, or arising out of
the conduct of this animal on or after the date of this adoption certificate.
5. ____I understand that ARF does not buy or sell animals, but finds homes for animals in need of a loving home. This
adoption application or the transfer of this animal pursuant hereto is not a sale.
6. ____I agree to allow, at ARF's discretion, an ARF representative to make an in home visit and understand that
ARF shall have the right to remove this animal from my home and care upon any misrepresentation in or breach
of this adoption application by me.
7. ____If I am adopting a pet that is too young to be altered I agree to have the alteration surgery done by 6 - 7
months of pet's age through the ARF program and ARF agrees to pay the fee for same provided it is done through
the ARF program.
8. ____If there is more than one individual applying to adopt this animal, each reference to "applicant", "I", "me" or
similar terms shall mean all such applicants.
ARF Adoption Fee Structure
ARF does not sell animals. The adoption fee you are asked to pay is not refundable and it helps to offset the
care your pet has received before you adopted it. ARF makes every effort to assure the pet you are adopting
is current with necessary vaccinations and is healthy.
ARF Non-refundable Adoption Fee _____For dogs $125.00____For cats $75.00
Total funds received by ARF in form of _____cash ____check _____check #_________
In witness wherefore, I hereby set forth my hand to this adoption application and indemnification agreement this
___ Day of _________, 20__
Applicant:______________________________________________
Signature
Animal Refuge Foundation of Wayne County, approved by: __________________________________________
(If approved, one copy must be kept by ARF and one copy given to new owner)
Signature
Revision 4 dated 4 September 2014