ADOPTION AGREEMENT

    
Please print form, fill out, sign & date. When ready to fax to the shelter, please call (706) 635-2166 to alert staff to an incoming fax, then send fax to (706) 635-2165 Please be aware the faxing of this form means you take full responsibility for said animal as indicated below. However, faxing this form does not automatically guarantee you the animal if said animal is not available, has already been adopted, if you are an ineligible applicant, or if any other prohibiting circumstances apply.  

Gilmer County Animal Control
115B Brett Dickey Memorial Drive
Ellijay, GA 30536 
(706) 635-2166

Adoption Agreement

PLEASE READ CAREFULLY
I HEREBY ACKNOWLEDGE RECEIVING FROM GILMER COUNTY, GEORGIA:

_____________________________________________________________________________________
(Description - GCAC animal code number, animal name, breed, gender, age, color etc.)

Which I agree to care for humanely and maintain in accordance with all laws and ordinances
in force in the community in which I reside. I agree to have said animal spayed/neutered by  ______________________, or the animal will revert ownership to Gilmer County, Georgia.

I acknowledge complete understanding of Title 4 of the Official Code of Georgia Annotated it reads as follows:

4-14-3. Sterilization of dogs and cats required; exceptions; costs.

(a) Any public or private animal shelter or animal control agency operated by political subdivision of this state, shall make provisions for the sterilization of all dogs or cats acquired from such shelter, by:

(1) Providing sterilization by a licensed veterinarian before relinquishing custody of the animal; or

(2) Entering into a written agreement with the person acquiring such animal guaranteeing that sterilization will be performed by a licensed veterinarian within 30 days after acquisition of such animal in the case of an adult or within 30 days of the sexual maturity of the animal in the case of an immature animal; provided, however, that the requirements of this Code section shall not apply to any privately owned animal which any shelter may have in its possession is the property of such person.

(b) All costs of sterilization pursuant to this Code section shall be the responsibility of the person acquiring such animal and. If performed prior to acquisition, may be included in any fees charged by the shelter for such animal.

(c) Any person acquiring an animal from a public or private animal shelter, or animal control agency operated by a political subdivision of this state, which animal is not sterile at the time of acquisition, shall submit to the animal shelter or animal control agency, a signed statement from the licensed veterinarian performing the sterilization required by paragraph (2) of subsection (a) of this Code section within seven days after such sterilization attesting that such sterilization has been performed.

(d) Every public or private animal shelter or animal control agency operated by a political subdivision of this state, selling or offering for sale or exchange any dog or cat shall maintain and furnish to any person acquiring an animal from such shelter, a current list of veterinarians licensed in this state who have notified the shelter, that they are willing to perform sterilizations and the cost for such procedures.

I Further understand that violation of Section 4-14 is a misdemeanor punishable by a fine of not more than $200.00. I further agree that I will not sell, trade, give away, or dispose of said animal in any way, but will return it to Gilmer County, Georgia. if at any time I desire to relinquish custody. I further agree that said animal shall not be used for vivisection or any other experimental purpose whatsoever.

The Gilmer County Department of Animal Control or its agent may examine and make inquiry about said animal at any time, and if not satisfied with conditions may reclaim custody of said animal, It is also understood that if I fail to comply with the terms of this agreement, said animal will be returned to the County or its designee and upon demand may take said animal into custody wherever said animal may be found.

Gilmer County, Georgia, or its agents, will not be responsible for any accidents, injuries or illnesses of any animal adopted. Any individual adopting any animal from Gilmer County assumes full financial responsibility; and releases Gilmer County from same. While Gilmer County agrees to make every reasonable effort to contact me at the expiration of the time shown on this contract, either by telephone, certified mail, or regular mail, I agree that this contract constitutes a final notice and no further notice is required for the County to institute legal action for violation of county law or the terms of this contract.

I HAVE READ AND UNDERSTAND THE ABOVE AND AGREE TO ABIDE BY ITS CONTENTS

Please Print Name   _______________________________________________________________

Address   ________________________________________________________________________

Phone     ____________________________________________

Drivers License #: ________________________          Social Security #: ____________________

Signature of Adopter (must be at least 18 years of age)

Signature ____________________________________________    Date______________________

Authorized Agency (must be at least 18 years of age)

Signature ____________________________________________    Date______________________

Veterinarian Performing Services __________________________   Date______________________

 

Return to Gilmer County Animal Shelter Home Page