PET APPLICATION

Name *
Name
Address *
Address
Birthday *
Birthday
Phone *
Phone
Your new pet
Do you want this pet for: *
Where will your pet be kept during the day? *
Where will your pet be kept during the night? *
Dwellings
Household
Current/Past Pets
Please list their name, type/breed, age, sex, if they were altered (spayed or neutered), where you keep them, and if you still own them.
Please provide the clinic's name, address, and phone number.
Please provide the clinic's name, address, and phone number.
Agreement
I hereby acknowledge and recognize the possible risk in viewing shelter animals, and that it can lead to serious injury. I hereby understand and assume the responsibility of any and all liability and risk visiting animals of Chicago Animal Advocates. I hereby waive and release Chicago Animal Advocates, its agents and representatives, from any and all claims which may accrue to me, my heirs, guardians, administrators, executors, or assignees, including my attorney's fees and court (collecting cost "claims") arising out of, or in the connection with visiting Chicago Animal Advocates or viewing an animal for adoption. I also grant permission to the Chicago Animal Advocates and its authorized agents to use my name, image, and any other record of my participation. *
Date *
Date