Chihuahua Rescue & Transport
Adoption Contract
Dog's Name: ______Microchip ID #: ______
Breed:______Color:______Markings:______WT______
Approx. Age: ______or Actual Birth Date: ___/___/_____
Sex:______Spayed/Neutered?: Yes / No Date of Spay/Neuter: ___/___/_____
Distemper/Parvo Vaccination: ___/___/_____ Bordetella: ___/___/_____
Rabies: ___/___/_____ 1yr or 3yr Vaccine
Heartworm test: Date ___/___/_____Result: ______
Heartworm preventative: Date ___/___/_____ Brand:______
Flea Preventative: Date ___/___/_____ Brand:______
Stool Test: Date ___/___/_____ Result: ______
Parasite treatment (if applicable): Date:___/___/_____ Medication: ______
Notes:______
______
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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.
______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.
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______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 seea vetwithin 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.
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Signature of Dog's new Guardian Date
______/____/_____
Driver's License NumberDate of Birth
______
Print Name of Dog's new Guardian
______
Street Address City State Zip Code
______
Home Phone/Fax Cell Phone Home E-Mail address
______
Business Email Business Phone/Fax Number
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This section to be completed by a CRT volunteer.
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______/____/______
Adoption Donation Received: Date Signature of CRT Volunteer
(Check or Money Order)
Notes: ______
______
Updated 07/09/13 Dog’s name:______Page 2 of 2