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: _____________________
Heart worm test (Date & results): _____________________________
Heart worm 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 heart worms, and if negative, is on heart worm preventative. I agree to continue giving Dog heart worm 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.
_______
I will contact a CRT volunteer immediately (within 24 hours) if the dog is lost, stolen or dead.
_______ If I cannot keep the Dog or provide appropriate care for the Dog for any reason, I will immediately return the Dog to Chihuahua Rescue & Transport ("CRT"). 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 wks & purchase 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 understand that CRT is not selling the Dog and any money given to CRT is a contribution towards the work of caring for animals.
_______ I agree to hold harmless CRT, or its volunteers, for any liability or damages, should this Dog become a problems to myself or 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.
_______ I agree that if I return the dog to CRT for ANY reason, the fee is not refundable.
_______ I agree to pay CRT the sum of $1,000 as liquidated damages in the event I breach the terms of this contract. The liquidation damage value to which I agree is for the purpose of establishing value of this pet and does not bar CRT from seeking return of the pet by judicial process or other legal means. I agree to pay all court costs and legal fees incurred by CRT in the enforcement of this contract.
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Print Name of Dog's new Guardian
_____________________________________________
___________________
Signature of Dog's new
Guardian
Date
_____________________________________________
Driver's License Number
_________________________________
Date of Birth
_________________________________________
_________________
Street
Address
City
__________________ __________________
State
Zip Code
__________________________________
________________________
Home
Phone
Business 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.
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___________________________________________
_____________________
Signature of CRT
Volunteer
Date
_______________________________
Fee Received
Notes: ______________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
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