Adoption Application & Contract

PRO TIPS FOR SUCCESSFUL SUBMISSIONS

There is no fee to submit an application. Once approved, your application is valid for a year.
Indicate which animal you are applying for AND the qualities you’d like in a pet. This way, if the pet you’re interested in is adopted by someone else, we can contact you when another animal that fits your criteria becomes available.
Ensure (Required) fields are completed. If you leave required fields blank, the application will not come through.
Click the pink “SUBMIT“ button when finished.
If successfully submitted, you will get a pop-up telling you so AND will receive a confirmation email.
Call us if you are having trouble: 603-539-1077.

Acknowledgment(Required)

I understand that LRHS does not “hold” pets for anyone as our goal is to get shelter pets into loving homes as quickly as possible. The adoption process requires an approved application, an appointment, and a good fit for both the shelter pet and adopter.

I'm interested in adopting(Required)

Please enter the criteria you’d like for your new companion. If you have a specific pet in mind, please add their name here(Required)

Adopter’s Name(Required)

Email(Required)

Enter Email Confirm Email

Home Phone(Required)

Cell Phone

Work Phone

Physical Address(Required)

Street Address Address Line 2 City State ZIP Code

Mailing Address (if different than Physical)

Street Address Address Line 2 City State ZIP Code

Current Veterinary Hospital

In order to process this application you will need to contact your veterinarian and grant them permission to release pet medical information to the Lakes Region Humane Society.

*If you do not own pets, please create an account with a veterinary hospital before submitting this application, and enter the information above. There are no fees involved in creating an account.

Vet's Phone

Past Veterinary Hospital

Past Vet's Phone

Is there a name besides yours that vet records would be listed under?

Are you able to safely maneuver up and down stairs?(Required)

Have you owned any cats or dogs in the past 7 years?(Required)

Pet #1

Name(Required)

Breed(Required)

Age(Required)

Sex(Required)

Spayed/Neutered?(Required)

Still owned?(Required)

If not, why?

Add a second pet?

Pet #2

Name(Required)

Breed(Required)

Age(Required)

Sex(Required)

Spayed/Neutered?(Required)

Still owned?(Required)

If not, why?

Add a third pet?

Pet #3

Name(Required)

Breed(Required)

Age(Required)

Sex(Required)

Spayed/Neutered?(Required)

Still owned?(Required)

If not, why?

Add a fourth pet?

Pet #4

Name(Required)

Breed(Required)

Age(Required)

Sex(Required)

Spayed/Neutered?(Required)

Still owned?(Required)

If not, why?

Add a fifth pet?

Pet #5

Name(Required)

Breed(Required)

Age(Required)

Sex(Required)

Spayed/Neutered?(Required)

Still owned?(Required)

If not, why?

Add a sixth pet?

Pet #6

Name(Required)

Breed(Required)

Age(Required)

Sex(Required)

Spayed/Neutered?(Required)

Still owned?(Required)

If not, why?

This field is hidden when viewing the form

Section End

Why are you looking to adopt (check all that apply)?(Required)

Protection

Companion

Mouser

Gift

Breeding

Other

What type of residence do you utilize?(Required)

Do you rent or own your home?(Required)

Landlord’s first and last name:(Required)

First Last

Landlord's Phone Number:

Landlord's Email(Required)

Enter Email Confirm Email

Who will become this pet’s guardian if you lose your home, move or are no longer able to care for this pet?(Required)

Are you willing to confine, clean up after, and feed your new barn cat in a large crate for a minimum of 2 weeks so they can learn that your structure is safe for them and you are the provider of their resources (this to encourage them to stick around rather than run away)

Thank you for considering the Lakes Region Humane Society for your new pet!

I, the adopter, pledge that the information provided within this Adoption Application is correct and true.

Adopter's Initials(Required)

By initialing here, you agree to the above.

Date(Required)

I am adopting:(Required)

PREAMBLE: I/We, the above named person and/or persons, hereinafter referred to as “adopter,” agree to adopt this dog/cat, hereinafter known as “dog or cat,” and release the Lakes Region Humane Society, hereinafter known as “LRHS” and its individual members, board members, and volunteers, jointly and severally, from all claims for personal injury and/or property damage to myself or others associated with this adoption. The adopter hereby declares that no representation about the nature of the adopted dog or cat, nor any representation regarding the nature and extent of legal liability or of responsibility have induced the adopter to sign this contract. The adopter acknowledges and further agrees to these provisions: to pay LRHS the adoption fee in cash, check or credit card format. Any amount given beyond the adoption fee will be considered a donation and is fully tax deductible, as LRHS is a 501(c)3 non-profit organization. Initial below to declare you understand:(Required)

HOME CARE: The welfare of this dog/cat is the sole responsibility of the adopter. The adopter agrees to give the dog/cat good care which includes: quality food, fresh water, sanitation and grooming, clean and secure indoor housing, clean and secure outdoor housing (for dogs only), overall safety, professional training when suggested by LRHS, exercise at least 3 times daily and all the tender loving care that this dog or cat deserves. Initial below to declare you understand:(Required)

HOUSING-TRANSPORT: Adopter will keep this dog/cat as a house pet and family member only. This dog/cat is not permitted to live in a dark or dirty garage, basement, doghouse or outbuilding that is not protected from severe cold and heat. When on public property, adopter will keep the dog on a leash and in control per NH State Law. Dogs must NEVER be left chained up. Dog may be "crated" for no more than 8 hours a day. The dog or cat will NEVER be permitted to ride in the back of a pick-up truck or left in a vehicle in extreme heat or unattended, per NH state law. Initial below to declare you understand:(Required)

VETERINARY CARE: After adoption, this dog’s/cat’s health is the adopter’s full responsibility. Adopter agrees to take the dog/cat to a veterinarian within a couple of weeks of adoption to verify its health status and to purchase heartworm preventative and flea/tick preventative medication. The dog/cat will receive proper care by a licensed veterinarian THROUGHOUT ITS ENTIRE LIFE, including ANNUAL EXAMS, ALL RABIES AND DHLPP SHOTS, as well as all other preventative and required treatments in accordance with veterinary recommendations for the LIFE OF THE DOG/CAT. Adopter will arrange for immediate veterinary care in the event of illness or injury. It is the belief of LRHS that the declawing of cats is cruel; therefore I, the owner, agree NOT to declaw this animal. Initial below to declare you understand:(Required)

COLLAR-LICENSING TAGS: Adopter will legally license this dog with their Town annually and will do so within ten (10) days of the adoption. Adopter agrees this dog/cat will NOT wear a pinch, cleat or choke collar of any sort by itself around the dog’s neck. Adopter will keep the dog/cat clearly identified immediately upon adoption and at all times with its license and identification tags with the pet’s name, owner’s name, address and telephone number. Initial below to declare you understand:(Required)

SPAY/NEUTER: BREEDING OF THIS DOG/CAT IS STRICTLY FORBIDDEN. If this dog/cat is not already spayed or neutered, adopter agrees to do so before the animal becomes 6 months of age or when your veterinarian recommends surgery. Adopter agrees to send a copy of the spay/neuter certificate to LRHS for reimbursement of spay/neuter deposit within ten (10) days of completion.(Required)

This dog/cat is already altered and the above provision does not apply.

This dog/cat needs to be spayed/neutered. Adopter will give a security deposit of $50.00, returnable within ten (10) days of receiving written proof from the veterinarian, that the dog/cat has been spayed/neutered.

Adopter understands that this is a requirement and not an option. The LRHS will follow up with adopter if written proof of spaying/neutering this dog/cat is not received within thirty (30) days of adopting this dog/cat. I agree to allow a representative of LRHS to enter my home and re-claim this animal should I fail to provide proof of spay/neuter after the animal is 6 months of age. Initial below to declare you understand:(Required)

CONDUCT & HEALTH OF DOG/CAT: Adopter understands that no one can predict how a dog/cat will react in a new situation. Therefore, adopter will exercise prudence and caution in introducing this dog/cat into any new situation until the dog/cat has become fully adjusted to its new environment and adopter has had an opportunity to become familiar with this dog’s/cat’s unique personality. Adopter assumes full responsibility for the conduct of this dog/cat, and for any damage to persons or property. LRHS makes no explicit or implicit guarantees in reference to the health and/or temperament of the dog/cat. The dog/cat is adopted “as is” and the adopter assumes all responsibility for treatment of any and all existing conditions or any other physical, medical or temperament changes that may occur in the future. LRHS cannot guarantee the health of any animal and shall not be held responsible for any medical expenses which may be incurred, hereby expressly excluding any implied or express warranties of merchantability or fitness for any particular purpose, including, without limitation, any warranties regarding health, temperament or whether the animal is housebroken. Initial below to declare you understand:(Required)

OTHER USES: This dog/cat will not be used for rituals, racing, fighting, medical or experimentation purposes. It will be nothing other than a well-loved, house pet, companion and family member. Initial below to declare you understand:(Required)

TRANSFER OF OWNERSHIP: The ownership and responsibility for this dog/cat belongs solely to adopter. If adopter can no longer keep this dog/cat or provide it with good care, including food, shelter or veterinary care, adopter agrees to first contact LRHS to inform them of the situation. The dog/cat shall NOT be sold, given to, or adopted to anyone else, nor there be transfer of ownership to any firm, corporation, or organization of other homeless animals, such as another rescue facility, or animal shelter without express permission from LRHS. Initial below to declare you understand:(Required)

FURTHER CONTACT: Adopter understands that LRHS may contact him/her for further verification of this dog’s/cat’s welfare. Adopter will cooperate by providing whatever information is requested and adopter will permit LRHS to visit the home or contact the veterinarian, if so requested. Adopter will keep LRHS informed of any changes of address, email address or telephone number so that adopter can be contacted for the life of the dog/cat. If the dog/cat becomes lost, adopter will notify LRHS immediately. Initial below to declare you understand:(Required)

REPOSSESSION: Adopter understands that in the event he/she does not follow the terms of this Agreement or adopter neglects or abuses the dog/cat, LRHS or another animal authority has the right to take possession of the pet. The adopter agrees to pay LRHS any and all expenses, including court costs and reasonable attorney’s fees, in enforcing the terms and provision of this contract. Initial below to declare you understand:(Required)

RETURNS: Adoption fees are non-refundable. Should you decide to return your adopted pet you will be required to set an appointment ahead of time by calling LRHS at 603-539-1077. Surrender fees range from $40-$150 and will apply should you decide to return your pet. If you are surrendering a dog due to behavioral issues and have not worked with a professional dog trainer to remedy the issue, an additional $50 breach of contract fee will apply. It is the hope of this organization that adopters take their commitment to their new pet very seriously. Remember, LRHS is a resource for you - ask us questions and voice your concerns before you become frustrated with your new pet. Initial below to declare you understand:(Required)

LRHS has provided the best information it can about the dog/cat, and adopter accepts responsibility for the dog/cat based on the information available and provided at the time of this Agreement. Adopter does not hold LRHS responsible for errors in the information provided about this dog/cat. Adopter realizes any rescue only knows what the previous owners have told it or very little in the case of a stray. The Release Statement below releases LRHS from any and all liabilities with respect to this dog’s/cat’s behavior, actions, health or performance. Adopter therefore forfeits any right to sue. Adopter understands that in the event he/she gives false information or does not follow the terms of this contract, LRHS may reclaim this dog/cat and start legal proceedings against adopter at adopter’s expense, and may assess damages in the amount of $1,000, plus legal fees, against adopter. Initial below to declare you understand:(Required)

RELEASE STATEMENT: Adopter(s) of the dog/cat identified in the Preamble of this Agreement, agree, understand and promises to forever release, discharge, indemnify and hold harmless LRHS, a 501c3 non-profit organization, or any of its agents or representatives, board members, or any other person associated with this rescue, their heirs, administrators, executors, successors and assigns from any and all claims, damages, costs, expenses, loss of services, actions and causes of action arising out of bodily injuries, mental anguish or property damage or any other occurrence from the present time on, caused by the adoption of this dog/cat. This includes any and all loss, damage, fees and expenses (including legal or medical fees) by reason of liability imposed by law upon LRHS or any of its agents or representatives, heirs, administrators, executors, successors and assigns because of bodily injuries or death to any person(s), or animal, including the adoptive owners, or any damage to property arising out of or in consequence of the placement of this dog/cat, howsoever such injuries, death or damage to property may be caused, whether or not the same may have been caused by, or may be alleged to have been caused by, negligence of the aforementioned parties or any of their agents or representatives, or any other person connected with LRHS. Adopter(s), the undersigned, assumes sole responsibility for all manner of actions and causes of actions, suits, debts, accounts, bonds, covenants, contracts, agreements, judgments, claims and demands whatsoever arising out of possession and/or the placement of this animal. Adopter also understands that this organization will not be responsible for any medical care or costs thereof required for this animal from this day forth. All expenses resulting in any injury or illness and all care will be adopter’s sole responsibility. In addition, adopter hereby agree that LRHS, its agents or representatives, board members or any other person associated with this rescue, their heirs and assigns, successors and executors, will not and cannot be held responsible for the conduct, behavior, health or disposition of this animal. Adopter shall assume all responsibility for damages, suits, death, debts and actions that arise from ownership of this animal. Adopter(s) realizes that adopter(s) hereby give up any right to take any legal action whatsoever against LRHS, its agent or representatives, board members, heirs, administrators, executors, successors and assigns. Unconfirmed and unverifiable information has been voluntarily provided to this rescue by its former owner, if known, but LRHS has undertaken no investigation with regard to the history or physical condition of the animal other than given by the previous owner (if known). LRHS, and any other agents or representatives, board members, executors, successors, agents and assigns, make neither warranty nor guarantee, expressed or implied, as to the physical, medical, mental or behavioral condition of this animal, its background or its suitability or compatibility. Adopter(s) therefore hereby releases LRHS, and all of its heirs, administrators, executors, successors and assigns, board members, and any other agents or representatives from any and all responsibility with regard to this adoption, which adopter(s) undertake voluntarily and with full knowledge of the above release and its implications.(Required)

I certify that I have read and understand the terms of this Pet Adoption Agreement and Release Statement by typing my name below.

Name:(Required)

Date(Required)

Representative Name:

Lakes Region Humane Society

Providing a safe and compassionate shelter for lost, abused or unwanted animals since 1995

The Lakes Region Humane Society cares for cats and dogs in need until they can be adopted, and promotes their health and welfare through community outreach and education.

Thinking of Adopting?

Adopting from LRHS gives you an opportunity to meet and bond with your future pet before making a commitment to adopt while providing a pet with a warm and loving home.

Volunteer today - make a difference in a pet’s life and in yours!

Whether your preference is dog walking, cat cuddling, office work or getting down and dirty to help clean, we will be sure to find a job for you!

There are many ways to donate to LRHS!

Monetary donations or donating items on our wish list like fleece fabric, Pedigree Chicken canned dog or poultry based cat food: find out how you can make a pet’s life a little brighter today!

PRO TIPS FOR SUCCESSFUL SUBMISSIONS

Pet #1

Pet #2

Pet #3

Pet #4

Pet #5

Pet #6

Section End

Resident #1

Resident #2

Resident #3

Resident #4

Resident #5

Resident #6

Section end

For Barn Cat Adoption

Thank you for considering the Lakes Region Humane Society for your new pet!

Upcoming Events

Providing a safe and compassionate shelter for lost, abused or unwanted animals since 1995

The Lakes Region Humane Society cares for cats and dogs in need until they can be adopted, and promotes their health and welfare through community outreach and education.

Thinking of Adopting?

Adopting from LRHS gives you an opportunity to meet and bond with your future pet before making a commitment to adopt while providing a pet with a warm and loving home.

Volunteer today - make a difference in a pet’s life and in yours!

Whether your preference is dog walking, cat cuddling, office work or getting down and dirty to help clean, we will be sure to find a job for you!

There are many ways to donate to LRHS!

Monetary donations or donating items on our wish list like fleece fabric, Pedigree Chicken canned dog or poultry based cat food: find out how you can make a pet’s life a little brighter today!

PRO TIPS FOR SUCCESSFUL SUBMISSIONS

Pet #1

Pet #2

Pet #3

Pet #4

Pet #5

Pet #6

Section End

Resident #1

Resident #2

Resident #3

Resident #4

Resident #5

Resident #6

Section end

For Barn Cat Adoption

Thank you for considering the Lakes Region Humane Society for your new pet!

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