H.A.R.F Adoption Application Form
Hawaii Animal Rescue Foundation, P.O. Box 515,
Puunene, HI 96784 Phone: 808-876-0022.

PERSONAL INFORMATION
Employer
Drivers License #
Email
Date of Birth
Spouse Work Phone
Spouse Employer
HOUSEHOLD INFORMATION
CHECK ONE
FOR RENTERS: Due to an increase in animal returns, we will be contacting your landlord or property manager for the approval of this adoption.
Landlord name or management company:
How long at current address?
Home environment is
Number of adults in Household
Number of children in Household
Ages of children
How often?
QUESTIONAIRE
I am adopting this pet for:
(WE PREFER GIFT CERTIFICATES)
Who will be responsible for the care and supervision of this pet?
Are you willing to keep this pet for its lifetime?
Are there any lifestyle altering events that could occur in your future? (i.e. new baby, moving, caring for elder, divorce, job uncertainty, health). If so, explain
I plan to spend
hours per day with this pet.
Veterinarian’s name
Who will care for your pet while you are away on vacation or out of town?
If yes, why? Please Explain
If yes, why?
Please explain.
All dog adopters MUST have one type of restraint in their yard for H.A.R.F. to approve the adoption and must be in place at the time we do your home inspection. If you have any questions regarding this policy, please ask.
How will the animal be secured on your property?
Where will the pet be kept?
What type of shelter will be provided?
If other please explain ... if dog house please describe its location.
Tell us about your past and present animals and dog to dog introductions. For the safety of all animals, households with existing dogs are suggested to have an introduction before a final adoption is made; if possible.
First at home pet breed
First at home pet name
Age
Where did you acquire this animal?
If you no longer have this animal, what happened?
Second at home pet breed
Second at home pet name
Age
Where did you acquire this animal?
If you no longer have this animal, what happened?
Third at home pet breed
Third at home pet name
Age
Where did you acquire this animal?
If you no longer have this animal, what happened?
Fourth at home pet breed
Fourth at home pet name
Age
Where did you acquire this animal?
If you no longer have this animal, what happened?

POLICIES FOR ADOPTION

Our adoption process seeks to make the best possible match between you and your new companion. First
and foremost, we are looking for permanent, responsible homes for our animals. Our knowledgeable staff
and Adoption Counselors can help you make an informed selection, provide you with useful information
on the animal(s) you’ve chosen, and assist you throughout the adoption process. Please take the time to
read through our adoption policies and guidelines. You are required to sign or agree with, this form both
acknowledging and accepting the terms of the adoption.

1. Children and Pets: Animal rescue discourages the adoption of certain animals, breeds or
temperaments to families with young children. In general, puppies should be at least 4 months of
age before being placed in homes where there are children under the age of 6 years old. Health
and humane authorities agree that a young child usually cannot be expected to handle a puppy
properly. Mishandling is likely to result in an injury to the child, the animal or both. Regardless
of age, children and animals must always be supervised when together.

2. Permission of the Landlord or Legal Property Owner Required: The Landlord or rental
agency will be contacted for verbal consent. Written permission in the form of rental agreements,
lease agreements or signed letters of consent are also accepted. In the case of multiple member
households, the legal property owner must also agree to the adoption before it is approved. WE
discourage the adoption of any animal to individuals living temporarily in the community.
Renters should be aware that it could be more difficult to find rental situations that accept pets.
You must be prepared to give a permanent home and lifelong care to the animal.

3. Adopters MUST be 18 Years of Age or Older to Adopt an Animal. Identification is required
to adopt any pet.

4. Adopters Will Allow for a Minimum 30-Day Adjustment Period. This is crucial for the animal
to adjust to its new environment and family. All adopters should be prepared to give the animal
proper training and guidance as you both get to know each other. (All dog adopters are
encouraged to enroll in basic obedience classes, which are offered at a discount for dogs adopted
from us). All adopters are encouraged to all us with any questions or concerns regarding their
newly adopted pet.

5. Animals Will Be Placed As Companion Animals Only! They are to be accepted as family
members, getting proper nourishment, medical care and attention. Adopters must be financially
able to provide for the animals needs, including food, supplies, licenses and veterinary care. Be
certain that you have adequate time to spend with your new pet, including time for training,
exercise and grooming. Continuous confinement without adequate exercise or human interaction
is not acceptable.

When you adopt an animal the price includes all 5-1 VACCINE AND 2 BORDETELLA VACCINES that
the animal is given before it leave us. The animal is wormed for round worms twice which means you
may see worms coming from this puppy for a while as they are expelled. The puppy package from us
includes all vaccines IF YOU RETURN to us to administer them, as well as the worming. The price also
includes spay/neuter and micro chipping IF you have it done by our veterinarians by the date that is
agreed upon before leaving the adoption site. Rabies inoculation is not administered since rabies does not
exist in the State of Hawaii. It is advised that you properly protect your pet from Rabies should you leave
the State. Please consult your veterinarian for details. WE DO NOT PAY FOR ANY MEDICAL
PROCEEDURES YOU DECIDE TO HAVE DONE FOR THIS ANIMAL.

The spay/neuter procedure MUST be completed within 14 days of the listed date at the bottom of this
page or HARF will only pay part OR NONE of the surgery depending on the circumstances. We pay by
the weight and the price goes up with the weight of the animal. We only pay the original amount, if at all.
This procedure is mandatory by state law and WE WILL REPOSSESS THE ANIMAL IF YOU DO NOT
COMPLY WITH THE LAW.

If your pet gets ill within the FIRST 5 DAYS you must NOTIFY US to find out what steps need to be
taken and which vet we assign it to. IF YOU CHOOSE TO GO TO ANY OTHER VET YOU ARE
RESPONSIBLE FOR ALL THE CHARGES. If you do not want the responsibility of caring for this
animal, please return it immediately.

We are a shelter and there are some health issues we have no control over. We never let an animal go if
we think anything is wrong with it but sometimes a problem will surface after a short time due to stress.
Please notify us FIRST and we will assign a vet to you. WE DO NOT PAY VET BILLS FROM
ANYONE OTHER THAN YOUR ASSIGNED VET. You must understand that these dogs have been
rescued from death row and they may have some health issues. Please be very careful about choosing
your pet and be prepared to handle whatever comes along.
DR. DEWEY, DVM – At Home Animal Hospital & Mobile Veterinary Services
(808) 873-0102
HANDLES SPAY, NEUTER AND ALL HEALTH ISSUES

H.A.R.F. ADOPTION AGREEMENT

(please print your name)
I,
1. I agree to pay the adoption fee which includes mandatory sterilization in compliance with
Federal & State ordinance and H.A.R.F. policy to control overpopulation of pets.

2. I agree that this animal can be reclaimed from my property if I fail to comply with the sterilization
requirements.

3. I agree to provide this animal with proper health care as defined by H.A.R.F.

4. I agree that if I can no longer keep this animal I will:
a. Return it to the Center, or
b. Notify the Center if I find another home.

5. I agree to tell the Center right away if this animal becomes sick within one week after adoption and to also do one of the following:
a. Return it to the Center and obtain a refund, less a $25.00 processing fee.
b. Exchange it for a healthy pet, or
c. Keep it and assume all responsibility for its medical care.
Your date of birth:

H.A.R.F.
DISCLOSURE AND RELEASE FORM

, the undersigned do hereby declare that I am aware that
1) I, (Please Print Name)
animals are different from human beings in their responses.

2) That the actions of animals are often unpredictable.

3) That animals should be closely supervised when they are with children.

4) That an animals’ behavior may change after it leaves the shelter and accustoms itself to a home or
other different environment.

5) We make no claims or representations as to the temperament, health or mental disposition of any
animal put up for adoption.

I hereby accept possession of, title to (subject to conditions in the adoption contract), and responsibility
for the animal I am adopting today and hereby release and discharge H.A.R.F. forever from liability for
any injury or damages to any person or, property caused in the future by said animal, and from any causes
of action, claims, suites or demands whatsoever that may arise as a result of such injury or damages.
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