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Pine Valley Shih Tzu Rescue
Adoption Agreement
DATE:_______________
NAME OF DOG:____________ BREED:____________ COLOR:____________
AGE:____________ SEX:____________ SPAYED/NEUTERED:____________
DISTEMPER/PARVO (DHLPP):____________ BORDETELLA:____________ RABIES:____________
BOOSTER DUE, DHLPP:____________ BORDETELLA:____________ RABIES:____________
PLEASE READ THE FOLLOWING BEFORE SIGNING:
Pine Valley Rescue requires a dog adoption fee of $____________ to help defray the expenses for food, boarding, and medical care. The adoption fee is not refundable.
I Agree that this dog is being adopted as a FAMILY PET and will be given extensive house privileges, i.e., sleep inside the house, supervised back yard exercise and always be on leash outdoors.
I will give the dog proper food, water, shelter, affection, exercise and grooming attention.
I agree to have the dog examined by a licensed veterinarian within 2 weeks of adoption. I agree to provide medical treatment whenever necessary, including booster shots.
I agree that the dog will be a companion animal. I will never tie the dog to the end of a rope or chain, and under no circumstances will I let the dog run loose unattended in the neighborhood.
I will not leave the dog alone for more than 6 – 8 hours.
I agree to protect the dog from harm and NEVER to give the dog onions, raisins, chocolate, rawhide or cooked bones which can be lethal to dogs.
I agree that if I cannot keep this dog for any reason, I CANNOT GIVE AWAY OR SELL HIM/HER. I will return the dog to Pine Valley Shih Tzu Rescue. At no time will a Pine Valley Rescue dog be surrendered to a shelter or humane society. I agree to pay the sum of $5,000.00 as liquidated damages in the event of breach of this part of the contract.
I understand that this dog was previously unwanted or lost and may have been rescued by Pine Valley Rescue from a dangerous, unhealthy and/or cruel situation. This could have long-lasting effects on the dog. You agree that Pine Valley Rescue is making no representations or warranties about the condition, lineage, personality or temperament of the dog.
Pine Valley Rescue is not liable for any claims, legal actions, losses, injuries, damages, costs, expenses or liabilities whatsoever in connection with my adoption or ownership of the dog.
*All Pine Valley adoptees are microchipped with an AVID chip*
REFERENCES (3)
NAME:
ADDRESS:
PHONE NUMBER:
____________________________________
NAME:
ADDRESS:
PHONE NUMBER:
____________________________________
NAME:
ADDRESS:
PHONE NUMBER:
___________________________________
PET INFORMATION
DO YOU CURRENTLY HAVE OTHER PETS? Y N
IF YES, TYPE OF PET AND NUMBER OF PETS:
HAVE YOU PREVIOUSLY OWNED PETS? Y N
IF YES, PLEASE EXPLAIN WHAT HAPPENED TO PET:
DO YOU HAVE SMALL CHILDREN? Y N
ADOPTER
SIGNATURE: ________________________
Date: ___________________________
PRINT NAME:
STREET ADDRESS:
CITY, STATE, ZIP:
HOME PHONE #:
WORK PHONE #:
CELL PHONE #:
E-MAIL ADDRESS:
VETERINARIAN NAME AND PHONE NUMBER:
Pine Valley Rescue
SIGNATURE:____________________________
DATE ________________________