First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Work Phone*
x

Cell Phone*

Alt Email

Emergency Contact #1 Name*

Emergency Contact #1 Phone Number*

Emergency Contact #1 Email Address*

Emergency Contact #2 Name*

Emergency Contact #2 Phone Number*

Emergency Contact #2 Email Address*

Name of Pet*

Former Name of Pet with PAS*

By signing below, I agree that entering my name and date will serve as my signature, and that I agree/understand/certify the following:

• I certify that the above information is correct and I understand that if any information listed here is incorrect, I may be charged an additional fee by the microchip company to correct.
• I understand that I will incur a one-time fee by PAS to enroll my adopted pet (lifetime registration) and this is not included in the adoption fee. 
•  I understand and agree to keep my pet enrolled with the microchip service to which s/he has been enrolled through PAS.
• I understand that if I utilize another company after the registration process through PAS: 1) I may put my pet at risk of not being reunited with me due to the policies of that company, including failure to pay any annually required enrollment fees enacted by such a microchip company, 2) that my pet and myself may not receive full benefits provided by the company, and that instead of being immediately and directly contacted, I may receive a robocall or email requesting that I contact the microchip company,  3) such policies would significantly delay reunion with my pet, and may result in release of my pet by a finder to the streets, an animal control facility, or an unknown third party.
• I understand and agree, that if PAS is contacted regarding a found pet, every reasonable effort will be made for the retrieval and safe confinement of the pet until such time that the pet's family can be located. If the adoptive family of record cannot be located after a period of 2 weeks, PAS will assume ownership of the pet.
• I understand and agree that an implanted microchip is not a full-proof means of reuniting a pet with their family for the following reasons:
  1) Not all parties who find a pet without visible ID may be aware of the need to have a pet scanned for a microchip at a vet office or animal care facility,
  2) Pets may fall into the hands of those with untoward motives, and who have no intention of returning pet,
  3) Microchips may failed to be recognized by a scanner due to equipment failure or user error.
• I agree that if my pet should ever become lost, with or without ID, I will proceed immediately with efforts to reunite with my pet including, but not restricted to:
  -Filing a lost report with the local animal shelter(s),
  -Posting lost signs in my neighborhood and at local vets offices,
  -Posting in lost and found pet pages/forums on social media and online neighborhood groups,
  -Reporting my pet lost to the registered microchip company.
• I understand that PAS has extensive experience in assisting owners in efforts to reunite with a lost pet, and I agree to contact PAS immediately if this pet is lost or stolen.
• I agree to notify any listed emergency contact that they have been designated as such and obtain their agreement to fulfill this obligation.
• I agree to create a plan of action with my emergency contacts for the recovery of my pet when found if he/she should ever become lost.
• I agree to keep my contact information updated with the microchip company and PAS whenever there are any changes.
• I agree that the adoption of my pet, and therefore the microchip registration is not transferrable, so I must contact PAS immediately if I can no longer keep my pet. 

Signature*

Date*