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2. Name*

   First and Last Name

3. Email Address*
5. Address*
7. City*
8. State*
9. Zip Code*
11. Phone Number*

    Include area code

12. Animal Interested In Being Adopted:

    Leave blank if general application. 

14. Do you have any animals now?*

    1. Yes
    2. No
15. If so, what animals and quantity*

    Example: 2 dogs; 1 cat; 1 bird

    If none, write N/A

17. Have you ever adopted a pet from us?*

    1. Yes
    2. No
18. If so, do you still have the pet(s)?

    1. Yes
    2. No
19. Have you ever adopted a pet from another animal shelter?*

    1. Yes
    2. No
21. I Wish To Adopt A Pet and I Understand the Following:*

    By checking the "I agree" box below, you agree and acknowledge that we reserve the right to refuse an adoption for any reason. All animals will be spayed or neutered, no exceptions. If for any reason you can no longer keep your pet, you MUST return it to the Shelbyville/Shelby County Animal Shelter.

    1. I agree.
23. Electronic Signature
25. Release of Liability for Animal Behavior/Health and other Important Information:*

    Undersigned further acknowledges that the taking of the dog/cat is not based upon any representations made by the Animal Shelter and/or any of its agents or officers as to the nature, behavior, or character traits of the dog/cat. Said animal is of the choosing of the undersigned. Undersigned in consideration of receiving the above-described animal does hereby release the Animal Shelter, its agents and/or officers, from any and all liability for any injuries or damages incurred by undersigned, which may be responsible. The Animal Shelter cannot make any guarantees of the health of the animal being adopted. It is the undersigned responsibility to contact a veterinarian within fourteen days from the time of the adoption. The Animal Shelter does not knowingly adopt out any sick animals therefore cannot take responsibility for an animal that gets sick once it leaves the facility. INDIANA STATE LAW- all dogs and cats over the age of 6 months must be vaccinated against rabies each year and wear the rabies tag. All animals must be under the control of their owners at ALL times. NO REFUNDS ARE GIVEN FOR ANY REASON. By signing this document, you understand and will comply with the rules of the Shelbyville/Shelby County Animal Shelter. We accept only cash or checks. Checks are to be made out to the : CITY OF SHELBYVILLE.

    1. I agree.
27. Electronic Signature
28. Date*
    Date

    Date
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field