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Driver's License Number:

Name of Animal:

I wish to Foster-to-Adopt this pet. I understand that I will be required to pay at least 1/2 of the adoption fee at this time. The Foster-to-Adopt period will be 2 weeks unless PCHS agrees to a longer time. If I return the pet, my fee will be refunded and this agreement will be void. If I keep the pet, I will pay any remainder of the adoption fee and the adoption will become final.

I wish to finalize this adoption nowI wish to foster-to-adopt this pet for a period of two weeks

Agreement

Acknowledgements: I acknowledge receiving custody of the animal described below and agree to the following: I will provide humane care, giving the animal proper food, water, shelter, and love. I will provide immediate, competent veterinary care in case of illness or injury. I will not attempt to hold PCHS, the delivering individual, or sponsoring organization responsible for any damages which the animal may do to any person or property.

Yes

Agreement. PCHS and the sponsoring organization are not responsible for any obligations, medical or otherwise, and make no claims or representations regarding the behavior, health, or temperament of animals put up for adoption. I also agree to return said animal to PCHS if for any reason I am unable to provide proper care for or keep said animal. I understand that home visits could be conducted at any time. If the terms of the agreement are not met, PCHS reserves the right to reclaim the animal.

Yes

Liquidated Damages Clause. I will not give or sell said animal to anyone. If for any reason I cannot continue to care for said animal, I will return it to the Polk County Humane Society. Liquidated Damages: Adopter agrees to pay to PCHS the sum of $150.00 as liquidated damages in the event that the terms of this contract are breached; this liquidated damage value is agreed to for the purpose of establishing the value of the animal and does not bar PCHS for seeking a return of the animal by a judicial process or other legal means. Attorney’s Fees and Court Costs: Adopter agrees to pay reasonable attorney’s fees and court costs in the event this matter is forwarded to an attorney for enforcement.

Yes

Signature / Date:

In accordance with the above contract, it is my understanding that PCHS may examine and inquire about the animal at any time, and if not satisfied with conditions, said animal shall be returned to PCHS. I have thoroughly read and agree to all of the above requirements. TYPE YOUR NAME AND THE DATE BELOW.