I have received from _______________ ______________ the $25.00 Post-A-Pooch-Plus listing fee for the adoption of my companion animal presently named ______________________.

By reimbursing me no more than the Post-A-Pooch-Plus listing fee of $25.00, the adopter is not purchasing this animal nor is the adopter receiving a give away free to a good home animal.

Please answer Yes, No or N/A (Not Applicable) to each, sign and date.

I stipulate that all information that appears on the Post-A-Pooch-Plus website regarding the health, behavior and history of this animal is accurate to the best of my knowledge.

I stipulate that all additional information given to the adopter about this animal is accurate to the best of my knowledge. This includes any and all veterinary records.

I took into careful consideration Post-A-Pooch-Plus safeguards that apply before agreeing to re-home my animal to the above named individual.

The safeguards for an appropriate placement include:

1. Utilizing the written list of pre-screening tips provided.

2. Following pre-placement home visit guidelines.

3. Checking the references of the adopter.

4. Receiving a signed landlord form if the adopter is a renter.

5. Consulting with the assigned Post-A-Pooch-Plus pre-placement counselor concerning any questions about re-homing.

6. Pre-arranging a plan of action should the re-homing not work out.

(Most present owners of record hold the $25.00 fee for two weeks and at the end of two weeks consider the re-homing finalized.  If the animal is returned within the two-week trial period, the $25.00 is usually returned as well.  The listing on Post-A-Pooch-Plus will not be deleted until the original owner of record notifies Post-A-Pooch-Plus that the re-homing is finalized.)

As a condition of re-homing, I require that should something happen to the adopter, a designated caregiver for the animal is pre-arranged. (Usually suggested if the adopter lives alone or has health concerns. The name and contact information for the designated caregiver should be made available before re-homing.)

If the adopter can no longer keep the animal after re-homing has been finalized, I would like to be notified.

If the adopter can no longer keep the animal after re-homing has been finalized, I would like the animal returned to me.

________________________________________ _____________
 Signature of Owner of Record                                      Date 

Address_______________________________________________

Home phone__________________

E-mail address_______________________