| Shelterluv

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Are you over the age of 18 years old? Yes No

Do you have any other pets? Yes No

What type of pet do you have now? Dog Cat Other

I certify that the above information is true. I also understand that giving false information on this survey is grounds for denying an adoption. This survey remains the property of CARE STL.

Liability Release: By submitting this application I acknowledge the following: I am at least 18 years of age and can provide valid picture identification. • I assume all risks associated with visiting the CARE STL Adoption Center, including, but not limited to, falls, contact with pets including pet bites and scratches, and contact with CARE STL visitors at the center. • I realize the risk associated with participating in the visitation of animals and the adoption process. • I hereby release the Center for Animal Rescue and Enrichment of St. Louis or CARE STL, including the City of St. Louis Department of Health, for all liability to myself, my family, my friends and relatives who I brought with me during my visit to CARE STL, my pet(s), and my property as a result of interaction with any animal in the shelter, including interaction in any animal housing area, in a Meet and Greet Room, Play yards, and Adoption Center lobby areas located at 2700 Walnut Adoption Center and 2801 Clark Avenue Animal Shelter.

*I have read and agree to the Terms and Conditions