Adoption Contract | Senior Dog Haven & Hospice

Dog Information

Dog's Name

Age

Breed

Color

Weight

Sex

Male

Female

Foster Parent

Adopter Information

Adopter's Name

Date of Birth

Driver's License #

Spouse/Partner's Name

Spouse/Partner's Date of Birth

Spouse/Partner's Driver's License #

Address

City

State

Zip

Home Phone

Cell Phone

Alt Cell Phone

Work Phone

Email Address

Alternate Email Address

Preferred method of contact

Method of Payment

Attestations

Please read the following carefully and agree to each statement. Note that Senior Dog Haven & Hospice shall hereafter be referred to as SDH&H.

I/We agree that this dog is being adopted for myself and will not be sold, rehomed, gifted or given to a third party for any reason.

Yes

I/We agree to treat this dog in a humane manner. I/we will provide adequate food, water, shelter, attention and interaction.

Yes

I/We agree that the dog will live inside the house as a member of the family.

Yes

I/We agree to allow a reasonable amount of time for the dog to become acclimated to his new environment.

Yes

I/We agree to never leave the dog tethered outside.

Yes

I/We agree to not leave the dog confined/crated for extended periods of time.

Yes

I/We understand that SDH&H makes no guarantees as to the temperament of this dog and SDH&H is not responsible for any future damages or injuries caused by the dog.

Yes

I/We understand that SDH&H makes no guarantees as to the health of this dog.

Yes

I/We agree to assume financial responsibility for any current medical condition and/or any medical condition that develops in the future.

Yes

I/We agree to provide routine medical care, including daily medications and supplements, if necessary.

Yes

I/We agree to take the dog to my veterinarian for an examination no more than 14 days from the date of adoption.

Yes

I/We agree to notify SDH&H within 30 days of a change in address, phone number or email.

Yes

I/We agree to keep a collar and ID tag on the dog, including his/her SDH&H ID tag.

Yes

I/We agree to notify SDH&H immediately if the dog were to become lost.

Yes

I/We agree to never submit the dog to elective or cosmetic surgeries or procedures.

Yes

I/We agree to be contacted by a representative of SDH&H in order to provide updates or progress reports on how the dog is adjusting.

Yes

I/We agree that if for any reason I/we find myself/ourselves unable to care for the dog, I/we will notify SDH&H and make arrangements to return hm/her. I further agree to allow SDH&H a reasonable amount of time to secure a foster home for the dog.

Yes

I/We avow that all family members agree to the adoption of the dog and will abide by the terms of the agreement.

Yes

I/We agree to immediately relinquish the dog to a representative of SDH&H should I/we violate any of the preceding conditions.

Yes

Release

The Adopter, and for his/her spouse, heirs, executors, personal representatives and assigns, agrees never to bring a claim or suit against Senior Dog Haven & Hospice. The Adopter releases Senior Dog Haven & Hospice and its founders, officers, directors, board, agents, volunteers and representatives from all liability arising from the adoption or behavior or actions of the dog.

The Adopter understands that this Agreement discharges Senior Dog Haven & Hospice and its founders, officers, directors, board, agents, volunteers and representatives from any liability to the Adopter and his/her spouse, heirs, executors, personal representatives and assigns, with respect to bodily injury, personal injury, illness, amputation, scarring, death, property damage or other loss that may result from the adoption or behavior or activities of the dog.

The Adopter has read this Release Agreement and fully understands that he/she will relinquish all claims or actions whether now known or discovered in the future agains Senior Dog Haven & Hospice and its founders, officers, directors, board agents, volunteers and representatives. Adopter is of legal age and legally competent to sign this agreement. Adopter is signing this agreement of his/her own free will.

Indemnity Agreement

The Adopter, and his/her spouse, heirs, executors, personal representatives and assigns, agrees to imdemnify and hold Senior Dog Haven & Hospice and its founders, officers, directors, board, agents, valunteers and representatives harmless for all bodily injury, personal injury, ilness, amputation, scarring, death, property damage or other loss, including attorney's fees and costs of litigation, that result to anyone else or any other entity because of Adopter's negligence or liability. This includes lone acts or ommissions by the Adopter as well as the combined acts of the Adopter with others.

The Adopter expressly agrees that the releases and indemnity agreement are intended to be as broad and inclusive as permitted by law. The Adopter agrees that in the event that any clause or provision of this agreement shall be held to be invalid by any court of jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this agreement. This is the entire agreement between parties and supercedes any other verbal or written statements, representations or promises.

I certify that I have read and understand the terms of this Adoption Contract, Release and Indemnity Agreement by submitting this form.

Yes

Adopter's Full Name

Co-Adopter's Full Name