ADOPTION CONTRACT
Tax
ID #: 27- 2581100
DATE____________ IMPOUND
#: ____________
PET NAME:_____ _________________________ MALE:_______ FEMALE:________
BREED:_______________ ____________ ALTERED: Yes ____________No________
MICROCHIP #:
AGREEMENT AND RELEASE ("Agreement")
By signing below, I hereby agree and acknowledge that I have made the informed decision to adopt the pet known as _____________________________ (more particularly described above, and referred to herein as the "animal") from Hands, Paws & Hearts, a California nonprofit Corporation exempt under Section 501(c)(3) of the Internal Revenue Code (hereinafter referred to as "RESCUER"). Further, by signing below, I hereby expressly warrant and represent that I have been made aware of, agree to and acknowledge each of the following (PLEASE initial each of the following conditions below to signify that you have read and agreed to each):
_______1. I am over eighteen (18) years of age;
_______2. I understand and agree that RESCUER reserves the right to reclaim the animal if any of the conditions described herein are not met by me. The RESCUER may also take immediate re-possession of the animal if it determines in its sole discretion that the animal is being mistreated, abused (either verbally or physically), neglected or otherwise put in or subjected to unsafe or unhealthy conditions. I agree to fully comply with surrendering the animal to RESCUER should RESCUER determine that the animal is being mistreated, abused, neglected or otherwise put in or subjected to unsafe or unhealthy conditions. Further, I shall indemnify RESCUER and its officers, directors, agents and employees, from any and all liabilities, claims, damages, costs (including reasonable attorneys fees) and/or responsibility incurred in connection with RESCUER’s taking possession of the animal in such circumstances.
_______3. I understand that a representative of RESCUER may make a follow-up visit, at a mutually convenient time, to ascertain that all conditions contained herein continue to be satisfied and that all warranties and representations made by me herein continue to be true and correct.
_______4. I warrant and represent that the animal will be housed at my home as a family pet, will sleep indoors at night, and shall have access to the residence. He/She will not be restricted to the yard nor tied there.
_______5. I acknowledge that RESCUER’s policy is TO PLACE ANIMALS AS FAMILY PETS ONLY and that I will be in material breach of this Agreement and my warranties and representations contained herein should I adopt the animal for any other purposes, whatsoever, including but not limited to for services as a guard
animal, and that RESCUER shall be entitled to the immediate return of the animal, as well as any and all other rights or remedies available to it under law, in such an instance.
_______6. I agree, warrant and represent that I will provide veterinary care and treatment when necessary. I will also make sure that fresh water and proper nutritional food will be available to the animal at all times.
_______7. I warrant and represent that I will socialize the animal with other animals for its well being.
_______8. I agree, warrant and represent that a personalized identification tag with my name and phone numbers will be kept on the animal at all times. The animal will be leashed, with a no slip collar or a harness and accompanied at all times in public areas, streets, parks, etc.
_______9. I AGREE, WARRANT AND REPRESENT THAT IF FOR ANY REASON I AM UNABLE TO KEEP OR PROVIDE ADEQUATE CARE FOR THE ANIMAL, I WILL, AS SOON AS PRACTICABLE, CALL VICKI ALEXANDER/LORI BROOKS TO SEE IF RESCUER CAN TAKE ANIMAL BACK( Please allow a minimum of 72hours for a response unless otherwise signed and agreed in this contract. In doing so, I also agree to provide reasonable assistance to Rescuer in order to find a new home for the animal and that I will foster the animal for up to three (3) months while working with RESCUER on allocating a new home for the animal (If the animal has been in the home with the adopter 3 or more months). I understand that turning the animal into any shelter/humane society/other rescue will result in fee’s to include any court costs, any kenneling fee’s, any fee’s associated with the return of the animal including boarding, transportation, gas, and time. At minimum the adopter will responsible for a $500.00 fee.
_______10. I agree, warrant and represent that I will not sell or give the animal to any other person including but not limited to friends, relatives, organizations, medical laboratory(ies), pounds or animal shelters.
_______11. I agree, warrant and represent that if I move to a new location I will notify RESCUER of my new address and phone number.
_______12. I agree, warrant and represent that I will notify RESCUER as soon as practicable should the animal become lost or missing, or upon the death of the animal.
_______13. I hereby release RESCUER, and RESCUER's officers, directors, agents and employees, from any and all liabilities, claims, damages, costs (including reasonable attorneys fees) and/or responsibility associated with my adoption of the animal, including but not limited to those resulting from (I) personal injury or property damage which I may suffer, (II) injury or damage caused by my intentional acts, negligence (gross or otherwise), or willful or wanton conduct, (III) the intentional acts, negligence (gross or otherwise), or willful or wanton conduct of third parties, (IV) the acts of the animal or (V) any medical or other treatment required for the health of the animal.
_______14. I hereby agree to indemnify and release RESCUER and its officers, directors, agents and employees from any and all liabilities, claims, damages, costs (including but not limited to attorney’s fees) resulting from any of my acts, omissions or failures to act, or relating to any acts of the animal, including but not limited to my negligence, intentional acts, gross negligence, or willful or wanton conduct.
_______15. I hereby agree, acknowledge, warrant and represent that RESCUER is not making, nor has it made, any express or implied warranties, including but not limited to any warranty of quality or performance with respect to the animal, the breed of the animal, the size the animal will become, or any medical issues that may result in the future. If the animal has any KNOWN medical issues, they will be described here and the adopter agrees that they will provide the necessary care and treatment for this condition.
_______16 . I understand that it is recommended that I make an appointment with my veterinarian within 48 hours to assess this animal for any medical conditions and to assess overall health. If there is a serious diagnosed medical condition, I will have the option to receive a full refund for the animal upon return of the animal. I understand that any other arrangements are strictly at the discretion of rescue organization and must be in writing.
_______ 17. Young Animals: I understand that because this animal is too young to be spayed/neutered I will be held responsible for having this animal spayed/neutered by 6 months old and provide a copy of the certificate to the Rescue Organization. Until such time, this animal is considered to be under a FOSTER CONTRACT and thus remains the sole property of the rescue organization.
PARVO: PARVO IS A DANGEROUS DISEASE THAT CAN BE CONTRACTED BY PUPPIES AND CAN BE FATAL. THE RESCUE MAKES EVERY EFFORT TO PROTECT AGAINST THE DISEASE THROUGH VACCINATION AND ISOLATION BUT AT TIMES THE DISEASE MAY ARISE. THE ADOPTER MAY CHOOSE THE FOLLOWING; TREAT THE ANIMAL AT THEIR VET AT THEIR OWN EXPENSE OR RETURN THE ANIMAL TO THE RESCUE FOR A FULL REFUND WITHIN TWO WEEKS.
_______ 18. Any dispute over the provisions of this Agreement and any other disputes among me and RESCUER shall be submitted to arbitration in accordance with the rules of the American Arbitration Association. Notwithstanding the foregoing, however, RESCUER shall not be prevented from obtaining injunctive or other equitable relief from a court of competent jurisdiction pending the resolution of a dispute through mediation or arbitration.
$______TAX DEDUCTIBLE GIFT
Adopting Party/Print Name________________________________________________
Date__________________________________________________________________
Address_______________________________________________________________
State & City ______________________________________Zip___________________
Home # __________________________ Work or Cell #_________________________
Signature __________________________________________________________
Email _____________________________________________________________
DONATION FOR THE ADOPTION OF THIS ANIMAL IS NON- REFUNDABLE AFTER TWO (2) WEEKS OF THIS CONTRACT BEING SIGNED AND REQUIRES THAT THIS ANIMAL BE RETURNED TO THE RESCUE ORGANIZATION IF A REFUND IS PROVIDED. ANY OTHER REFUNDS ARE AT THE DISCRETION OF THE RESCUE ORGANIZATION.
PET NAME:_____ _________________________ MALE:_______ FEMALE:________
BREED:_______________ ____________ ALTERED: Yes ____________No________
MICROCHIP #:
AGREEMENT AND RELEASE ("Agreement")
By signing below, I hereby agree and acknowledge that I have made the informed decision to adopt the pet known as _____________________________ (more particularly described above, and referred to herein as the "animal") from Hands, Paws & Hearts, a California nonprofit Corporation exempt under Section 501(c)(3) of the Internal Revenue Code (hereinafter referred to as "RESCUER"). Further, by signing below, I hereby expressly warrant and represent that I have been made aware of, agree to and acknowledge each of the following (PLEASE initial each of the following conditions below to signify that you have read and agreed to each):
_______1. I am over eighteen (18) years of age;
_______2. I understand and agree that RESCUER reserves the right to reclaim the animal if any of the conditions described herein are not met by me. The RESCUER may also take immediate re-possession of the animal if it determines in its sole discretion that the animal is being mistreated, abused (either verbally or physically), neglected or otherwise put in or subjected to unsafe or unhealthy conditions. I agree to fully comply with surrendering the animal to RESCUER should RESCUER determine that the animal is being mistreated, abused, neglected or otherwise put in or subjected to unsafe or unhealthy conditions. Further, I shall indemnify RESCUER and its officers, directors, agents and employees, from any and all liabilities, claims, damages, costs (including reasonable attorneys fees) and/or responsibility incurred in connection with RESCUER’s taking possession of the animal in such circumstances.
_______3. I understand that a representative of RESCUER may make a follow-up visit, at a mutually convenient time, to ascertain that all conditions contained herein continue to be satisfied and that all warranties and representations made by me herein continue to be true and correct.
_______4. I warrant and represent that the animal will be housed at my home as a family pet, will sleep indoors at night, and shall have access to the residence. He/She will not be restricted to the yard nor tied there.
_______5. I acknowledge that RESCUER’s policy is TO PLACE ANIMALS AS FAMILY PETS ONLY and that I will be in material breach of this Agreement and my warranties and representations contained herein should I adopt the animal for any other purposes, whatsoever, including but not limited to for services as a guard
animal, and that RESCUER shall be entitled to the immediate return of the animal, as well as any and all other rights or remedies available to it under law, in such an instance.
_______6. I agree, warrant and represent that I will provide veterinary care and treatment when necessary. I will also make sure that fresh water and proper nutritional food will be available to the animal at all times.
_______7. I warrant and represent that I will socialize the animal with other animals for its well being.
_______8. I agree, warrant and represent that a personalized identification tag with my name and phone numbers will be kept on the animal at all times. The animal will be leashed, with a no slip collar or a harness and accompanied at all times in public areas, streets, parks, etc.
_______9. I AGREE, WARRANT AND REPRESENT THAT IF FOR ANY REASON I AM UNABLE TO KEEP OR PROVIDE ADEQUATE CARE FOR THE ANIMAL, I WILL, AS SOON AS PRACTICABLE, CALL VICKI ALEXANDER/LORI BROOKS TO SEE IF RESCUER CAN TAKE ANIMAL BACK( Please allow a minimum of 72hours for a response unless otherwise signed and agreed in this contract. In doing so, I also agree to provide reasonable assistance to Rescuer in order to find a new home for the animal and that I will foster the animal for up to three (3) months while working with RESCUER on allocating a new home for the animal (If the animal has been in the home with the adopter 3 or more months). I understand that turning the animal into any shelter/humane society/other rescue will result in fee’s to include any court costs, any kenneling fee’s, any fee’s associated with the return of the animal including boarding, transportation, gas, and time. At minimum the adopter will responsible for a $500.00 fee.
_______10. I agree, warrant and represent that I will not sell or give the animal to any other person including but not limited to friends, relatives, organizations, medical laboratory(ies), pounds or animal shelters.
_______11. I agree, warrant and represent that if I move to a new location I will notify RESCUER of my new address and phone number.
_______12. I agree, warrant and represent that I will notify RESCUER as soon as practicable should the animal become lost or missing, or upon the death of the animal.
_______13. I hereby release RESCUER, and RESCUER's officers, directors, agents and employees, from any and all liabilities, claims, damages, costs (including reasonable attorneys fees) and/or responsibility associated with my adoption of the animal, including but not limited to those resulting from (I) personal injury or property damage which I may suffer, (II) injury or damage caused by my intentional acts, negligence (gross or otherwise), or willful or wanton conduct, (III) the intentional acts, negligence (gross or otherwise), or willful or wanton conduct of third parties, (IV) the acts of the animal or (V) any medical or other treatment required for the health of the animal.
_______14. I hereby agree to indemnify and release RESCUER and its officers, directors, agents and employees from any and all liabilities, claims, damages, costs (including but not limited to attorney’s fees) resulting from any of my acts, omissions or failures to act, or relating to any acts of the animal, including but not limited to my negligence, intentional acts, gross negligence, or willful or wanton conduct.
_______15. I hereby agree, acknowledge, warrant and represent that RESCUER is not making, nor has it made, any express or implied warranties, including but not limited to any warranty of quality or performance with respect to the animal, the breed of the animal, the size the animal will become, or any medical issues that may result in the future. If the animal has any KNOWN medical issues, they will be described here and the adopter agrees that they will provide the necessary care and treatment for this condition.
_______16 . I understand that it is recommended that I make an appointment with my veterinarian within 48 hours to assess this animal for any medical conditions and to assess overall health. If there is a serious diagnosed medical condition, I will have the option to receive a full refund for the animal upon return of the animal. I understand that any other arrangements are strictly at the discretion of rescue organization and must be in writing.
_______ 17. Young Animals: I understand that because this animal is too young to be spayed/neutered I will be held responsible for having this animal spayed/neutered by 6 months old and provide a copy of the certificate to the Rescue Organization. Until such time, this animal is considered to be under a FOSTER CONTRACT and thus remains the sole property of the rescue organization.
PARVO: PARVO IS A DANGEROUS DISEASE THAT CAN BE CONTRACTED BY PUPPIES AND CAN BE FATAL. THE RESCUE MAKES EVERY EFFORT TO PROTECT AGAINST THE DISEASE THROUGH VACCINATION AND ISOLATION BUT AT TIMES THE DISEASE MAY ARISE. THE ADOPTER MAY CHOOSE THE FOLLOWING; TREAT THE ANIMAL AT THEIR VET AT THEIR OWN EXPENSE OR RETURN THE ANIMAL TO THE RESCUE FOR A FULL REFUND WITHIN TWO WEEKS.
_______ 18. Any dispute over the provisions of this Agreement and any other disputes among me and RESCUER shall be submitted to arbitration in accordance with the rules of the American Arbitration Association. Notwithstanding the foregoing, however, RESCUER shall not be prevented from obtaining injunctive or other equitable relief from a court of competent jurisdiction pending the resolution of a dispute through mediation or arbitration.
$______TAX DEDUCTIBLE GIFT
Adopting Party/Print Name________________________________________________
Date__________________________________________________________________
Address_______________________________________________________________
State & City ______________________________________Zip___________________
Home # __________________________ Work or Cell #_________________________
Signature __________________________________________________________
Email _____________________________________________________________
DONATION FOR THE ADOPTION OF THIS ANIMAL IS NON- REFUNDABLE AFTER TWO (2) WEEKS OF THIS CONTRACT BEING SIGNED AND REQUIRES THAT THIS ANIMAL BE RETURNED TO THE RESCUE ORGANIZATION IF A REFUND IS PROVIDED. ANY OTHER REFUNDS ARE AT THE DISCRETION OF THE RESCUE ORGANIZATION.
