CLUMBERS IN NEED
Kim Smith McLendon, Founder
19 Trantham Creek Road - Fairview, NC 28730
Email:
Website: www.clumbersinneed.com
Phone: (828) 230-2499
ADOPTION AGREEMENT
New Owners:
Name: ______Address: ______
Home Phone: ______Cell Phone: ______Email: ______
Married: ___ Single: ___ Name of Significant Other: ______Cell Phone: ______
Name of Employer: ______Position: ______Phone: ______
Address: ______Days & Hours at Work: ______
Name of Vet Clinic: ______Phone Number: ______
New Pet:
Name: ______Microchip Mftr: ______No#: ______* ______* ______
Dog: ____ Puppy: ____ Breed: ______Birthdate: ______M/F: ______
Colors: ______Spay/Neuter Date: ______
Medical History:
DHLP Booster (w/Lepto): ______Frontline Plus: ______Wormed: ______
Canine Bordatella: ______Heartworm Tested: ______H/W Preventative: ______
Rabies Date (1 yr or 3 yr) ______Rabies Tag No#: ______Rabies Agency: ______
TERMS & CONDITIONS
Please initial after reading each one and sign and date on the last page
1. I will provide love and companionship for this Clumber Spaniel. _____
2. I will provide food, water, shelter, humane care and exercise for this Clumber and otherwise properly care for and never mistreat this Clumber. _____
3. I will provide vaccinations including Rabies and follow-up boosters to keep this Clumber healthy. _____
4. I will provide a fenced yard for the adopted Clumber. A dog house and tether is not considered sufficient and will not be acceptable as a replacement for a fenced yard. Failure to maintain a fenced enclosure for the Clumber will result in forfeiture of the adoption and immediate return to Clumbers in Need. Further, should it be determined that the Clumber is tethered in the fenced yard then the adopter forfeits possession of the animal and will immediately surrender it to Clumbers in Need. _____
5. The adoption fee may be refunded (on a pre-arranged basis) if things don’t work out with the Clumber only up to two weeks post adoption if it is in the opinion of Clumbers in Need that the adopter has made a sufficient attempt to integrate the animal into the household. _____
6. I acknowledge that Clumbers in Need has provided me with records from the Clumber’s veterinarian(s) for the past ___ months and I have agreed to adopt this Clumber “as is” without warranty by Clumbers in Need as to health, temperament or mental disposition and that Clumbers in Need is not liable for the temperament, health, or mental disposition of the Clumber. If I adopt, as the new owner, I accept full responsibility for this Clumber, releasing and discharging Clumbers in Need from any injury and/or damage to persons or property by this pet and any action, suits, claims, or demands that arise as a result of such. _____
7. I will comply with all applicable Laws and Ordinances relating to pets and dogs in force that applies in the area in which I live. _____
8. I understand that this clumber is co-owned by Kim Smith McLendon and if for any reason I cannot keep this Clumber, I will return it to Clumbers in Need. I understand I may NOT place this pet in a new home. I will NEVER turn over the Clumber to any shelter nor will I make any LIFE ALTERING decisions such as those involving major surgery, terminal illness or euthanasia regarding this Clumber without first contacting Clumbers in Need. ____
9. If the pet is missing or lost, the director of Clumbers in Need and your local shelter or Animal Control Agency MUST be contacted immediately. DO NOT WAIT! _____
10. Clumbers in Need reserves the right to do follow up home inspections and/or phone calls to insure the Clumber’s welfare. Should it be found that there has been a breech of the conditions of the contract, Clumbers in Need reserves the right to demand relinquishment of the adopted Clumber to its custody. In this situation no request for refund of the adoption fee will be honored. Further, any costs related to regaining custody will be the responsibility of the adopter and may be collected by any legal means deemed necessary. _____
11. I will notify Clumbers in Need within three days if I have a change of address and/or phone number(s). _____
I understand that the above conditions apply and that they constitute a legally binding contract. I have read these conditions carefully, have understood all terms of this contract and will abide by them.
I understand if I do not comply, I forfeit all right to ownership and possession of the Clumber Spaniel. If legal action is necessary, I agree to pay any and all expenses (including legal expenses) incurred by Clumbers in Need.
I am 18 years of age or older.
______
Applicant’s Signature Driver’s License No# Date
______
Spouse or Significant Other’s Signature Driver’s License No# Date
______
Kim Smith McLendon - Witness Date
1