Please list all the pets you currently own (i.e., financially responsible for)
Please list the pets you have owned (up to three pets)
Liability Release & Statement of Understanding:
Recognizing the possibility of physical injury associated generally with the care and handling of animals, I acknowledge that I/my child are assuming a risk of injury by coming into contact with animals owned by the Humane Society of Greater Dayton (”HSGD”). I hereby agree to release, discharge, defend and indemnify the HSGD, its directors, officers, employees and volunteers, from and against any claims, costs, expenses, liabilities, injuries, damages and attorneys’ fees which I or my child may suffer or claim to suffer as a result of contact with HSGD animals. This release is intended to explicitly and specifically release the releases from their own negligence, be it active, passive or gross, or alleged as thus. This release is further intended to cover all derivative claims which arise or may arise out of any events, losses or claims which may arise hereunder.
I hereby give my consent to HSGD and those acting on their behalf to publish and use photos or videos of me or my child/family on their website, social networking sites and/or other promotional materials at the discretion of HSGD. All right, title and interest in any such images shall be owned by HSGD. I hereby release, discharge, indemnify, and agree to save harmless HSGD and its employees, agents, and volunteers from and against any loss, liability, costs, and expenses arising, directly or indirectly, from HSGD’s publication or use of such images or my likeness, including, without limitation, any claims for invasion of privacy or right of publicity, or loss or liability resulting therefrom.
I understand the responsibilities that I am assuming if I adopt this animal. I understand that the HSGD DOES NOT guarantee the health or behavioral disposition of any animal and therefore there may be unforeseen expenses and circumstances, including vet visits, etc. with the introduction of a new pet in my household.
I hereby give the HSGD my permission to contact my landlord, if applicable, and my veterinarian to verify any of the information supplied in this application. I also agree to a “progress check” in the future, where a HSGD worker may visit my home to verify my new pet’s living conditions. I agree that if I am unable to keep this pet for any reason, I will contact the Humane Society of Greater Dayton.
By signing below, I acknowledge that I understand everything I have read in this application and I have answered all of the questions truthfully. I further understand that the HSGD is considered the owner and guardian of the animal in question and has the right, in its sole discretion, not to approve this application.