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REDEMPTION SONG RESCUE LEAGUE
12475 Sunset Blvd., West Palm Beach, Florida – 33411
ADOPTION AGREEMENT

Drivers License information will be requested when you adopt. Please have your drivers license with you.

You must be at least 18 years old to adopt and you must be the primary caregiver for the pet.

Name

Date of Birth

Address

Cell Phone

City/Zip

Home Phone

Your Email

Driver’s License

State

Ages of the children

Who are you adopting this pet for ?
 Yourself Other

How Long have you lived at your current address?

Do Children visit?
 Yes No Sometimes

Have you adopted from Redemption Song Rescue League before?
 Yes No

Please provide an emergency contact: (must be someone outside of your home that will always be able to contact you:

Your Name

Phone

HOW DID YOU HEAR ABOUT US?

TYPE OF ANIMAL

Sex
 Yes No

SPAYED OR NEUTERED
 Yes No

CURRENT ON VACCINATIONS
 Yes No

I’d like to receive information via e mail about the following:
 Volunteer Opportunities Fostering Events and Fundraisers Donation Info Do not E mail

THIS APPLICATION IS PART OF OUR CONTRACT
I Certify that all of the above information is true and accurate. I understand that if I adopt a pet from the League this document will become part of the adoption record. I understand that the League provides no guarantee of any pets age, behavior, breed, general disposition, or aggressive or vicious tendencies. This pet may be destructive, and may not be housetrained. I will provide proper and sufficient food water, shelter and medical treatment for my new pet at my expense, including immunizations, heartworm prevention, flea protection and licensing. I also understand that all adoption fees are considered donations and are non refundable. Please note that if for any reason you can no longer care of your new pet, you must return him/her to Redemption Song Rescue League yourself. I hereby release Redemption Song Rescue League from any responsibility for the above animal.

PAYMENT INFORMATION

Payment method
 Cash Credit

Amount ($)

Credit Card Number

Exp. Date

Security Code

Located on back of card

Signature

Printed Name

Date

Animal Number

Store number