This guideline can be used as a Placement Agreement when a candidate has been approved to adopt a rescue dog. Please read this document and answer all areas completely.
This Agreement is freely agreed upon and entered into on this the ______day of ______, 20_____ between ______hereinafter referred to as “Placement Agent” and the following individual(s), hereinafter referred to as “Adopter”.
Name:
Home Address:
City, State, Zip:
E-Mail Address:
Home Phone:
Cell Phone:
Work Phone:
Whereas, Adopter wishes to adopt the following dog, known as and described as follows:
Dog’s Name:
Color:
Breed:
Sex:
Age (DOB if known):
Spayed \ Neutered:
Microchip \ Tattoo (or other identifying) number:
The above named participants do freely and willingly agree to abide by this legal contract as follows:
1. Adopter agrees to make a non-refundable donation of $ ______for each dog adopted from Placement Agent. This donation shall be used to offset any expenses incurred for in the care of the aforementioned dog such as (but not limited to): boarding, grooming, food, veterinary care, training, etc.
2. A licensed veterinarian has examined the aforementioned dog. A copy of all veterinary care provided to the aforementioned dog, while in the care of Placement Agent, will be provided to the Adopter.
If the dog's past veterinary records have been provided (by a previous owner, shelter or alternate animal organization), Placement Agent will provide a copy of these records to the Adopter. However, Placement Agent cannot assure the completeness or accuracy of any prior veterinary care or records.
3. Adopter shall immediately provide the dog with a comfortable and safe leash and flat collar or harness. A Gentle Leader type head collar is also appropriate. No choke, prong, spike, electronic shock or correction collars of any material will be used on the dog.
A sturdy and securely connected identification tag will be attached to the flat collar or harness. The identification tag must include the Adopter last name, city\town and state and a phone number in readable script. Adopter shall not allow the dog outdoors, at any time, without proper identification on the dog.
4. All dogs will be spayed\neutered prior to placement, by a licensed veterinarian of our choice. Adopter will reimburse Placement Agent for the cost of the spaying\neutering at the time of the adoption.
5. If a dog is ill or requires treatment for heartworms or another medical condition prior to sterilization, he or she will be spayed\neutered after their recuperation period at which time placement may take place.
6. We strongly recommend Adopter enroll the dog into a positive training “Good Manners” course (or Puppy Kindergarten class if dog is under 4 months of age) within 3 months of the adoption date. Adopter agrees to the following:
· A training deposit of $100.00 will be provided to Placement Agent at the time of the adoption.
· Adopter agrees to complete a minimum of a 6-week “Good Manners” training course instructed by a positive trainer. Adopter agrees to enroll the dog in a “Good Manners” training course by the following date: ______
ADOPTER'S INITIALS:
7. Once the Adopter and dog have completed the “Good Manners” course (#7), Adopter agrees to send a copy of the graduation certificate from the trainer to Placement Agent. Once the certificate is received, Placement Agent will return the $100.00 deposit within 30 days. If the training course charge exceeds the $100.00 deposit, Adopter assumes all responsibility for payment of training fees in excess of $100.00. If Adopter fails to complete the training course then Adopter forfeits the $100.00 deposits
8. Adopter agrees to abide by all local, city and state laws pertaining to the ownership of dogs including (but not limited to) licensing and leash laws. Adopter agrees to license the dog in accordance with local regulations.
9. Adopter understands that adopted dogs typically will require time to adjust to their new homes and surroundings. This includes attitude and house-training adjustments. Adopter agrees to allow a minimum of 4 weeks adjustment period for dog. Placement Agent will provide individual instructions regarding the dog and re-homing to Adopter.
10. The dog is being adopted as a companion only. Any other use other than as a companion will be considered a breach of this contract.
11. Adopter agrees to abide by the following conditions in regards to care and ownership of the dog:
· Adopter shall treat the dog humanely, particularly with respect to the provision of adequate food, water, shelter, veterinary care and human companionship. Adopter will never verbally, physically or emotionally abuse the dog; nor will Adopter allow any other person or animal to verbally, physically or emotionally abuse the dog.
· Adopter will not leave the dog in the care of any individual(s) who by age and\or mental capacity is not capable of responsibly caring for and insuring the safety of the dog.
· Adopter will never allow the dog to run loose, unless in a secured, fenced in area and under human supervision.
· Adopter will never leave the dog unattended in a car for any period of time.
· Adopter will not allow the dog to be used for medical or experimental purposes, dogfights or any illegal activities.
· If the dog is lost, stolen or deceased, Adopter shall immediately notify Placement Agent.
12. Adopter shall not keep the dog outdoors for extended periods of time, always considering the weather and the dog's general health and safety. It is clearly understood that the dog is an indoor companion. Indoor housing is to be provided at all times and at no time will the dog be housed outside.
13. Adopter shall not chain or tie the dog, either inside or outside, for an unreasonable period of time (in excess of one hour; less if weather is hot, cold or inclement), and never without abundant moving space, access to water and food and responsible human supervision at all times.
14. Adopter agrees to abide by all State laws in regards to Rabies vaccine and will ensure that booster vaccinations and other routine vaccinations will be done as required. These may include (but are not limited to): Distemper, Lyme, Bordetella, and Heartworm. Adopter agrees to have a licensed veterinarian provide appropriate Rabies vaccine to the dog. Puppies are required by law to have their first rabies vaccine by 16-weeks of age. They are then required to have a second Rabies vaccine within one (1) year from the date of the initial Rabies vaccine. After that, your veterinarian may choose to administer either an annual (given once a year) Rabies vaccine or a 3-year Rabies vaccine (given once every 3 years). Consult with your veterinarian to determine which method is appropriate for your dog.
15. Adopter shall provide routine and emergency veterinary care as needed.
16. Placement Agent may make inquiries about and\or examine the dog at any time, upon reasonable notice to Adopter. Adopter shall not withhold from Placement Agent access to the dog or the dog's medical records. Adopter shall promptly respond to any Placement Agent concerns about the status and condition of the dog.
17. If Adopter resides in housing, which is rented, Adopter shall obtain written permission from the landlord prior to the dog's placement with Adopter. A copy of the lease approving pets in the rental housing will be acceptable. A copy of this permission shall be provided to Placement Agent.
18. Adopter shall not transfer, sell, give away, remove, or dispose of, or in any other way change custody of the dog from the Adopter to any other person, entity or organization. If Adopter can no longer keep the dog, Adopter must contact and speak with the Placement Agent (information and signature at the end of this contract) in order to arrange the return of the dog to the Placement Agent.
19. If Adopter can no longer keep the dog and the Adopter is more than 20 miles from the Placement Agent, then Adopter assumes sole responsibility and expense for returning the dog promptly and safely to Placement Agent.
Clauses #19 and #20 mean the Adopter agrees to physically return the dog to a safe location determined by the Placement Agent. The Adopter shall immediately notify the Placement Agent of intent to return the dog and shall give Placement Agent adequate notice (at least 72 hours) to secure another place for the dog.
ADOPTER'S INITIALS:
20. Adopter will notify Placement Agent of any change of address or location where the dog is being kept.
21. In the event that Placement Agent determines, in his\her sole discretion, that Adopter is not providing adequate food, shelter, veterinary care or is otherwise in breach of this contract and any of its obligations herein, Placement Agent shall be entitled to take back the dog and make appropriate arrangements for the dog's care and\or re-homing. Should such an event occur, the donation made by Adopter shall be forfeited.
22. It is expressly understood by and between the parties that Placement Agent makes no representations, guarantees or warranties about the dog whatsoever, including (but not limited to) the following:
· Health, temperament, intelligence, trainability or compatibility with any other person(s), animals(s), entities, locations, or objects.
· The dog's ability to reasonably adjust to Adopter's home.
· Previous ownership of the dog.
23. It is expressly understood by and between the parties that Placement Agent may have little or no information or records for the dog or about the dog's history. Adopter agrees to adopt the dog although little or no information has been provided to Adopter. Adopter expressly understands that the dog is adopted AS IS.
24. Adopter shall not hold Placement Agent liable or responsible for any veterinary care or treatment, training or behavior counseling for the dog, now or in the future.
25. Adopter expressly agrees to indemnify and hold harmless Placement Agent and any of its agents, representatives and volunteers for and against any and all manner of actions and causes of actions, suits, debts, dues, accounts, bonds, covenants, agreements, judgments, claims, and demands whatsoever arising from or relating to the adoption, placement and\or possession of the dog.
26. Adopter expressly agrees to indemnify and hold harmless Placement Agent and any of its agents, representatives and volunteers for and against any and all damage and\or injury caused by the dog to any other person(s), animal(s) or thing(s).
This is a legally binding contract. No provisions of this contract may be altered, modified or in any way changed unless the same is in writing. This contract contains the entire agreement by and between the parties.
I have read and fully understand this contract, and I agree to fully abide by all the conditions, promises, terms and covenants I have made.
Adopter's Signature: ______
Adopter's Name (print): ______
Placement Agent Authorized Representative Signature:
______
Effective Date: ______
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