2018 HAA Adoption Application & Agreement
Adoption Application
Which dog/puppy are you considering for adoption? If you are not sure yet, please put still looking. Also, if there are multiple ones you are considering, please list all. *
Your answer
Your Name: *
Your answer
Phone: home & cell # with the area code *
Your answer
Address with the City, State, and Zip code *
Your answer
Email Address: *
Your answer
Employer/Employment Status: *
Your answer
Please list the names and ages of all persons living in your home. *
Your answer
Does anyone in your family have allergies? If so, what will you do if a family member is allergic to this dog? *
Your answer
Will this be an inside dog or outside dog? *
Your answer
Where will the dog be when the owner is home? *
Your answer
Where will the dog be while home alone? *
Your answer
Where will the dog be at night? *
Your answer
How will the dog be cared for if the owner is vacationing or for any reason has to be away? *
Your answer
Do you have a fenced yard? (this is not necessarily a requirement) *
Required
If no, how do you plan to let the dog out and keep the dog safe from traffic or running away?
Your answer
How close do you live to a street or road?
Your answer
Do you own your home or rent? *
Required
If you rent, please list the landlord's name and phone #.
Your answer
What pets are currently living in your home and their names? *
Your answer
Are your pets indoor or outdoor pets? *
Required
Name and phone # of your veterinarian or vet clinic? *
Your answer
At the vet clinic, what is the owner's name your current pet(s) are listed under? *
Your answer
Have you ever adopted a pet? *
Required
If yes, when and from where?
Your answer
Do you agree to have a shelter representative visit your home prior to adoption? *
Please list two personal references and their contact information. These should be persons that can verify that your home is a safe and dog friendly environment. *
Your answer
How did you hear about us? *
Your answer
ADOPTION AGREEMENT
A printout of this application/agreement will need to be signed when you pick up your new fur baby.
For and in consideration of $ _________, and the mutual promises contained herein, the parties agree to the following terms of adoption, to wit:

In accordance with the "Tennessee Spay/Neuter Law" as set forth in T.C.A. Section 44-17-502, et seq., Hardeman Adoptable Animals, Inc., and/or the Hardeman County Animal Control Shelter, hereinafter referred to as "agency," does hereby offer for adoption and new owner does hereby accept for adoption the identified dog:

1. For any dog that has not been spayed or neutered, the new owner shall have the above identified dog spayed or neutered by a licensed veterinarian:

(a) Within thirty (30) days of the date of the adoption, if such dog is sexually mature; or

(b) Within thirty (30) days after the dog reaches six (6) months of age, if the dog is not sexually mature at the time of adoption.

Nothing in this section shall preclude the spaying or neutering of a sexually immature dog at the discretion of a licensed veterinarian with the consent of the new owner.

2. If the dog being adopted has not been spayed or neutered, the new owner may request and shall receive a refund of one hundred dollars ($100) from the agency upon providing confirmation of the spaying or neutering.

If the new owner fails to have the above identified dog spayed or neutered within the time frame established by Section 44-17-502, or if the spaying or neutering is timely performed, but the new owner fails to request the return of the deposit within an additional fifteen (15) days after the date by which the spaying or neutering is required to be performed, such deposit shall be forfeited to the agency.

3. If the adoption fails to comply with the provisions set forth herein and set forth in T.C.A. Section 44-17- 502, et. seq., the agency may file a petition with a court competent jurisdiction seeking compliance and/or requesting return of the dog to the agency from which it was adopted.


Adopter's Name (PLEASE PRINT) _______________________________________


Adopter's Signature_________________________________________________ Date ___________


Agency Representative______________________________________________ Date ___________

*Note - " Tennessee has a state law (§ 44-8-408) makes it a crime to allow a dog to run at large. The dog must be under control at all times if out. "
By submitting this application, I certify that the information given is true and that I recognize any misrepresentation of the facts may result in my losing privilege of adoption. I authorize investigation of all statements on this application.
If filling out online, when you have successfully submitted the application you will see "Thanks for submitting your adoption application."
I have read and understand the adoption agreement. I further understand that if I feel I cannot keep the dog for ANY reason I MUST return him/her to the animal shelter, and MUST NOT sell/give him/her to anyone else. *
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