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2. First Name*
3. Last Name*
5. Pet Name*
7. Species*
   -- Select One --DogCat
8. Vaccinated*
   -- Select One --YesNo
10. Date and time of Appointment*
    Date and time of Appointment

    Date and time of Appointment

12. The Adoptee agrees to contact Sumner Spay and Neuter or a Veterinary Clinic of choice for an appointment for spay/neuter and a rabies vaccination within 30 days of adoption date. Portland Animal Control reserves the right to reclaim ownership of the adopted animal if this contract is not fulfilled. 

16. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
18. Electronic Signature*
Leave This Blank:


20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

* indicates a required field