Polk County Humane Society (PCHS) Adoption Agreement & Release

Name of Animal:

I acknowledge receiving custody of the pet(s) described above. I agree to provide humane care, giving the pet(s) 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 Polk County Humane Society (PCHS) or the delivering individual responsible for any damages which the animal may do to any person or property.

I agree that PCHS is not responsible for any obligations, medical or otherwise, and makes no claims or representations regarding the behavior, health, or temperament of pets put up for adoption.

I understand that I am responsible for all vaccinations, veterinary care, medications and preventatives from the time I adopt this pet forward (with the exception of young pets that are scheduled to be returned for their neuter/spay surgery). I agree to provide vaccinations, care, medications and preventatives as recommended by my veterinarian.

I will not give or sell this pet to anyone without permission from PCHS. If for any reason I cannot continue to care for this pet, I will first attempt to return it to PCHS.

Liquidated Damages: I agree to pay to PCHS the sum of $150.00 as liquidated damages if the terms of this contract are breached. This liquidated damage value is agreed to for the purpose of establishing the value of the pet and does not bar PCHS from seeking return of the pet by a judicial process or other legal means. I agree to pay reasonable attorney’s fees and court costs in the event this matter is forwarded to an attorney for enforcement.

I understand that PCHS may examine and inquire about the pet at any time. If PCHS is not satisfied with conditions, said pet shall be returned to PCHS. I have thoroughly read and agree to all of the above requirements..

Please take a picture of your driver's license or other picture identification. This is required by state law for licensed rescues like Polk County Humane Society.

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