Adoption Agreement


Greenbrier Humane Society    

P.O Box 926 Lewisburg, WV 24901

(304) 645-4775



Please read carefully


Office Staff

Adoption Date: _________________________                 Intake Number:  ________________________

Animal Name: __________________________                 Surgery date: _________ Vet: _____________ Breed/Color/Markings: ____________________            _____________________________________________

Age: _____________    Sex: __________                             Dog: ________      Cat: ________


Adopter’s Name: ________________________________________________________________________________________

Mailing Address:__________________________________________________________________________

City & State:________________________________________________   Zip Code:___________________

Physical Address:__________________________________________________________________________

Main Phone Number: _________________________________     Secondary Phone:_________________________

E-mail Address: ___________________________________________________________________________


Adoption Fee Amount: $______________   Microchip: ________   Extras:____________________________________________



Total Adoption Cost: $____________________ 

Check: _____  Cash:_____ Charge:_____

I do hereby acknowledge receipt from the Greenbrier Humane Society [hereinafter GHS] the animal described above and understand that GHS makes NO warranty with regard to health, temperament, or former ownership of the animal.  I accept it in its present condition. I understand the animal may have been exposed to diseases prior to entering this facility or while in the facilityInitial Here_____


GHS cannot be held responsible for any veterinarian bills or services after the animal leaves the facility.  Initial Here_____


I understand that this animal may not be sold or given away, but must be returned to GHS without refund (except as noted below).  It is the legal right of the GHS to reclaim any animal harmed by neglect or mistreatment and to invoke statutory civil and criminal penalties where applicable.

Initial Here_____


GHS reserves the right to make a personal inspection of the animal any time after adoption to ensure that it is receiving proper care.  Initial Here_____


It is GHS policy that ALL animals adopted must be spayed/neutered before they are allowed to leave our facility. If the animal is not old enough for spaying/neutering, then a contract must be signed and accompanied with this adoption agreement stating that the animal will return for its surgery.

Initial Here_____


Although we de-worm all adopted pets, we cannot guarantee the pet to be free of intestinal parasites.  We HIGHLY recommend that your new pet be taken to the veterinarian of your choice within 30 days of adoption for a fecal test as well as a health checkup.  Initial Here_____


The animal(s) must have on its body at all times the following forms of identification: an ID TAG bearing the name and telephone number of the owner, a current WV RABIES tag and COUNTY tax tag (dogs only). County Tags can be purchased at the County Courthouse from the County Assessor’s Office.  Initial Here______


REFUND POLICY: Should the animal described above become ill and die within 48 hours of adoption, and proof of such is submitted to GHS, a full refund of adoption fees will be made.  If the animal is kept beyond the 48-hour period and no report made to GHS of illness and death, NO REFUND WILL BE GIVEN.  Initial Here_____



______________________________________________                                                     Date: ___________________

Adopters Signature


______________________________________________                                                     Date: _____________________

GHS Representative


We offer Microchipping for an extra $15.00 on all NEWLY adopted animals!

If your pet gets lost and makes its way into a facility with a microchip scanner they can call 24 Pet Watch or the implanter and reunite you with your beloved pet!

$15.00 is a small price to pay for this

safe and permanent method of identification!