Chihuahua Rescue & Transport
Adoption Contract

Date:  ___________________

Dog's Name:  ___________________________    Breed: _____________________________

Color: __________________  Age:  ______________ Birth Date:  ______________________

Sex: ____  Spayed/Neutered?:  ______________   Date of Spay/Neuter:  ________________

Distemper/Parvo vaccination:  __________________________________________________

Rabies vaccination:  __________________________________________________________

Heartworm test (Date & results): _________________________________________________

Heartworm preventative (type & date of last medication):  _____________________________

Flea Preventative (Type & date of last application): __________________________________

Stool Test (Date & results of last test): ____________________________________________

Parasite treatment (Date & reason for treatment if applicable):  _________________________

Other:  _____________________________________________________________________

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_______ I promise to provide the dog described above (Dog) with a good, safe, warm home, quality food, clean water, all necessary medical care and love for the said Dog.

_______ I understand that said Dog has been tested for heartworms, and if negative, is on heartworm preventative.  I agree to continue giving Dog heartworm preventative in accordance with the direction of the veterinarian.  I agree to have the Dog visit the veterinarian for all necessary medical care not less than once a year.

_______ I understand that the Dog is to live in the house.  I agree that I will not keep the Dog outside except for reasonable periods of time as needed by the Dog. The Dog will not be allowed to roam nor will the Dog be physically restrained to any inanimate object (trees, cable run, etc.). I will buy and use a crate if needed and/or advised.                                   Page 1 of 3

_______ I will contact a Chihuahua Rescue and Transport (CRT) volunteer immediately (within 24 hours) if the Dog is lost, stolen or dead.

_______ I will immediately return the Dog to CRT if I cannot keep the Dog or provide appropriate care for the Dog for any reason.  I understand that I cannot sell or give the Dog to another person, shelter, dealer or business.                                     

_______ I will comply with all state and local ordinances in the confinement, care, and licensing of this pet. I will reclaim this pet promptly, and pay any required fees if it is picked up by an animal control agency. Rabies and ID tags will be kept on the animal at all times.

_______ I agree that CRT representatives may enter my property and recover the Dog if in the sole opinion of CRT I have not complied with the terms of this agreement.

_______ I understand that the health, age, nature or temperament of the Dog is not guaranteed and that CRT is not responsible for any defect the Dog may have or develop.  By adopting the Dog, I agree to have the Dog examined by a veterinarian at my expense.  I agree that all future medical treatments are my responsibility, unless CRT has agreed to pay for them in this contract. I will see a vet within 2 weeks and purchase a 6-month supply of heartworm preventative.

_______ I agree to allow a visit/call by a CRT representative at a mutually agreeable time at any time after this adoption, to verify the well being of this animal. I agree to email or phone updates within two weeks and then as requested.

_______ I agree to hold harmless CRT, or its volunteers, for any liability or damages, should this Dog become a problem to myself or to others.  I understand that this Dog's background may or may not be known.  CRT has evaluated this Dog's behavior to the best of its ability and will not be held responsible should the Dog prove to be any sort of danger to any other animals, humans or possessions.

_____________________________________________  
Print Name of Dog's new Guardian

_____________________________________________           ____________
Signature of Dog's new Guardian                                                    Date

_____________________________________________            
Driver's License Number

_____________________________________________                                          Page 2 of 3
Date of Birth

____________________________________________    ____________________________   
Street Address                                                                     City

_______________    _________________
State                          Zip Code

_______________________    _______________________   _________________________
Home Phone                             Business Phone                        Cell Phone

_____________________________    _________________________________
Home E-Mail address                            Business E-Mail Address

_____________________________     _________________________________
Home Fax Number                                Business Fax Number

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                                        This section to be completed by a CRT volunteer.
                                    ************************************************************

___________________________________________    __________________
Signature of CRT Volunteer                                              Date

_______________________________
Adoption Donation Received:

Notes: 

___________________________________________________________________________

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