ADOPTION AGREEMENT
SECAUCUS ANIMAL SHELTER
525 Meadowland Parkway
Secaucus,NJ07094
(201) 348-3213
Cat Application
Cat(s)/ Kitten(s) you are interested in adopting: ____________ _
Color and qescription: _____________________ _
Please fill out this application completely so we can process it effectively.
When answer choices are offered, please check all that apply.
Please read and INITIAL the following:
· • We reserve the right to perform a home visit. __ _
• We reserve the right to approve or deny any adoption for"any reason and the
right to not disclose the reason. ___ _
• You must be at least 18 years of age to apply; if you live at home, a parent must
complete the application. ____ _
• The application process takes up to and can exceed 2-3 business
days. ___ _
• The application is good for 1 year from the approval date. ____ _
• We offer no guarantee on breed, health, mental disposition on any adopted
pets. ____ _
• Payment is by Cash or Check ONLY. ____ _
• Adoption fees are non-ref~ndable. Once adopUon is complete there are NO
REFUNDS for any reason. You are responsible for the new pet in its
entirety. ____ _
• · If animal is too young to be spayed or neutered at time of adoption an additional
deposit of $150 is due and refundable once proof of spay/neutering is
received.
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Personal Information
Today's Date:------'-----------
Applicant: ________________________ _
Co-Applicant: ______________________ _
Relationship: Spouse__ Parent __ Roommate
Partner __
Other _______ _
Address: ________________________ _
City: ____________ _
State: ________ _
Zip Code:______ Primary Phone#: ___________ _
Email: ____________ Alt. Phone#: ________ _
Driver's License: ____________ State Issued: _____ _
Applicant's Occupation: ____________________ _
Applicant's Employer: _____________________ _
Name of Supervisor:--~----------
Phone: __________ _
Co-Applicant's Occupation: __________________ _
Co-Applicant's Employer: ___________________ _
Name of Supervisor: ____________ _
Phone: __________ _
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Prospective Pet Information
Why do you want to adopt a cat: Check all that apply:
Companion ____ _
Gift
----
For Child ___ _
Other _______ _
Does anyone in the house have animal allergies? __________ _
Please list your preferences for cat/kitten (ex: age I sex/ breed I size/ personality):
In the past 30 days, have you applied for a pet in another rescue/shelter? Yes/ No
. If yes, where? ____________________________ _
Home Situation
Please list names and ages of all members of household:
Do you: Own or Rent your home? ____________ _
How long have you lived at this address? __________ _
If you rent: Name of Landlord: _____________ _
Phone: _______ _
Do you have a homeowners Association or a Property Management Company that manages your
community area?
If yes, Name: __________________ Phone: ________ _
Please circle all that apply:
Do you plan to declaw your cat/kitten?
Where will this pet be kept during the day?
Where will this pet be kept during the night?
Yes
Inside
Inside
No
Outside
Outside
Do you plan on moving from your current location in the next 3 years?
Yes
Both
Both
No Unsure
Are all household members interested in adopting a cat and are active in its adoption? Yes No
Responsibility:
How many hours will this pet be left alone on a typical work day? ________ _
Is anyone home during the day? _______ If yes, who? ________ _
Where will the cat sleep? _____________________ _
Who will care for this pet while you are on vacation? ____________ _
Are you willing to take responsibility for this pet for the next 1 O + years? Yes No
Do you understand changing a cat's environment may cause the cat to have accidents? Ye~ No
Do you understand that it can take cat several months to adjust to other pets in the house and its new
· home atmosphere? Yes No
What circumstances would cause you to return this animal? ______________ _
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If a behavioral problem arises, what steps will you take to correct it? ____________ _
As part of our adoption process, we may require a home visit.
Are you willing to have a home visit? Yes No
If no, please explain. _______________________ _
If your living situation changes, what plans do you have in place for the animal?------~-
Who will be responsible for care for the animal until plans are made?
{NAME)
{PHONE#)
Current and past pets:
Have you adopted from Secaucus Animal Shelter previously?
Yes No
If yes, please list names, breeds and years adopted . __ ___ _ _ ____ _ _
· Do you currently own any PETS?
Breed
Age Sex Neutered?
MIF
MIF
MIF
MIF
YIN
YIN
YIN
YIN
Declawed? How long?
YIN
YIN
YIN
YIN
If your current pet hasn't been spayed or neutered, please explain why. ___ _ _____ _
Have you owned any PETS in the past 5 years you no longer -own? Yes No
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If yes, please explain: _ __ _______ __ ____ __ ____ __ ___ _
Have you ever released a pet to an animal shelter or given away an animal? Yes No
If yes, what were the circumstances? ____________ _ _________ _
Have you ever had a pet euthanized for any reason other than old age? Yes No
If yes, what were the circumstances? _ ___ ___ _____________ _
You agree to return the PET you are adopting to the Shelter if you cannot keep it. _____ _
INITIALS
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Vet Reference
Name of veterinary/Animal Hospital for current pets: -----,-------------
Phone#: __________ _
In whose name are the records listed? _______________ _
Name of Veterinarian/Animal Hospital for past pets: _______________ _
Phone#: __________ _
In whose name are the records listed? ________________ _
Personal References:
List two personal references (two non-family) with name, phone, and relationship. It would be beneficial
to have a neighbor's reference. Do not use your veterinarian as a personal reference.
1. ____________________ ,Phone: _________ _
2. ____________________ P,hone: _________ _
Please notify your references that we will be calling, many references require permission from the applicant to
release information.
Has anyone in your household ever been convicted of an animal-related charge? Yes · No
Disclaimer & Release:
I have read the above information carefully and have filled out the questions honestly. I understand that
omission of information and/or failure to answer all questions can result in my application being denied.
I also understand the adoption decision is dependent on many factors including but not limited to
compatibility of the family and home to the individual animal. Secaucus Animal Shelter reserves the
right to refuse the adoption of an animal to anyone for any reason.
By signing YOUR NAME and submitting this form to the Secaucus Animal Shelter, I signify that all information
given in this application is true and correct, to the best of my/our knowledge.
Also by signing this form, I authorize the release of my pet(s) medical information from the veterinarians or animal
hospitals listed on this application.
Signature of Applicant: ________________ Date: __ / __ ___,/
Signature of Co-Applicant: , _______________ Date: __ / __ __,/
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For Office Use Only:
Veterinarian Reference:
Name of Vet spoken to: __ _ ____ __ ____ _
Phone Number of Vet: _ _ ____ __ ___ __ _
Staff Member making the call: ________ _ __ _
Acceptable Reference: Yes I No
Comments:
- - --- - ----- - ---- -- ----- -
Personal References (2):
1
Name of reference:
--- -- ---- - -----
Phone Number of Reference: __ __ ___ __ _ _
Staff Member making the call: __ ____ __ __ _
Acceptable Reference: Yes I No
Comments : _ __ _ ____ __ ___ ___ ____ ___ _ --'-----
2
Name of reference :
-- --- -- --- -- ---
Phone Number of Reference: _ ____ _ ____ _
Staff Member making the call: _ ___ ___ __ _ _
Acceptable Reference: Yes I No
Comments: _ __ _ ____ __ ____ __ ______ _____ _ _
SECAUCUS ANIMAL SHELTER
525 Meadowland Parkway
Secaucus, NJ-07094
(201) 348-3213
ADOPTERS AGREEMENT - CAT
Secaucus Animal Shelter agrees to do the following:
1. Give the Adopter title to, possession and control of the Pet as described: For so long as the
ADOPTER complies with the terms of this contract.
2. Provide ADOPTER with any and all veterinary records available for the Pet along with current
medications.
IN RETURN, THE ADOPTER AGREES TO THE FOLLOWING :
(INITIAL each statement)
3·_ ADOPTER agrees to pay a NONREFUNDABLE adoption fee.* ___ _ _
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4. ADOPTER agrees to keep the Pet as a pet and companion and not to abandon, trade, give away, or
sell it; nor is the Pet to be used or sold for commercial use or research purposes . If the ADOPTER no
longer desires or is unable to keep the Pet within the terms of this contract the Pet must be returned to
SECAUCUS ANIMAL SHELTER. * _ _ __ _
5. ADOPTER agrees to provide adequate food, water, exercise, and medical care at all times; and care
for the Pet in a devoted and humane manner for the remainder of its natural life. * ____ _
6. ADOPTER agrees to have the Pet examined by a licensed veterinarian at least once a year,
maintain appropriate vaccinations and other preventive health and dental care, and provide copies of
the Pet's care records to SECAUCUS ANIMAL SHELTER upon request. * ____ _
7. ADOPTER agrees the Pet shall reside within the ADOPTER'S home.* ____ _ _
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8. ADOPTER agrees to keep the Pet under the ADOPTER'S control and not let the Pet roam freely
outside.* _____ _
9. ADOPTER must notify SECAUCUS ANIMAL SHELTER IMMEDIATELY if the Pet becomes lost.*
10. ADOPTER must update any contact information including phone and address. * ____ _
11. ADOPTER agrees that during the Pet's lifetime SECAUCUS ANIMAL SHELTER may visit the
premises where the Pet is kept. In the judgment of the SECAUCUS ANIMAL SHELTER, if the Pet is not
being adequately cared for or ADOPTER has not complied with any provision of this contract, the pet
will be removed from ADOPTER. * ____ _
12. ADOPTER agrees to pay all costs necessary to enforce this agreement including attorneys' fees,
costs of litigation, Pet recovery fees, and all medical bills to restore the Pet's health back to adoptable
status.* ____ _
13. The ADOPTER agrees that if the pet is found running at large or is brought into a pet facility for any
reason, the ADOPTER authorizes any .animal care or control agency to release the Pet back, to the
Secaucus Animal Shelters, hereby designated as Agent for the ADOPTER. * ____ _
14. ADOPTER acknowledges that the Pet is adopted "as is" and that no implied or expressed
warranties have been made by SECAUCUS ANIMAL SHELTER in reference to the health, training
and/or temperament of the Pet. SECAUCUS ANIMAL SHELTER shall not be held responsible for any
veterinary expenses after adoption of the Pet or held liable for any misrepresentations unknown to the
SECAUCUS ANIMAL SHELTER.* ____ _
15. ADOPTER certifies that neither ADOPTER nor anyone residing in ADOPTERS household has ever
been charged with or convicted of crimes against animals or humans, including but not limited to
neglect, abuse, or housing animals in unsanitary living conditions.* ____ _
16. ADOPTER understands that should the Pet cause personal injury or property damage after
adoption, the SECAUCUS ANIMAL SHELTER shall in no way be liable in whole or part for that damage
and hereby assumes and agrees to hold SECAUCUS ANIMAL SHELTER harmless from any and all
liability for the Pet, or any injury or damage that may be caused by it. ADOPTER hereby waives all
claims, losses, or damages which may arise after the adoption of this Pet, caused by any act or
omission by SECAUCUS ANIMAL SHELTER which results in personal injury or property damage to
any person by this Pet, and the ADOPTER agrees not to bring any legal action seeking any remedy
against SECAUCUS ANIMAL SHELTER in connection with this agreement or in connection with
personal injuries or property damage claimed to result from any act or omission by SECAUCUS
ANIMAL SHELTER whether by ADOPTER or any third party.* ____ _
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17. BY SIGNING BELOW ADOPTER CERTIFIES THAT THEY HAVE DONE ALL POSSIBLE
RESEARCH, PREPARATION, AND UNDERSTANDS THE NEEDS OF CARING FOR A PET.
ADOPTER HAS READ A COPY OF AND UNDERSTANDS THAT EVERY ANIMAL IS AN INDIVIDUAL
AND WILL NEED TO BE CARED FOR AND RESPECTED AS AN INDIVIDUAL. ALL ANIMALS
NEEDS AND CHALLENGES ARE DIFFERENT. ADOPTER UNDERSTANDS AND AGREES TO ALL
TERMS OF THIS CONTRACT.
Signature of Applicant: ______________ Date:--'----''--
Signature of Co-Applicant: _____________ Date:--'--~'--
Secaucus Animal Shelter: _____________ Date: __ / __ _,/ __
