Adopter's Name     _______________________________________________

Adopter’s Phone    _______________________________________________

Adopter’s Address _______________________________________________


Former Owner's Name     ____________________________________________

Former Owner’s Phone    ____________________________________________

Former Owner’s Address ____________________________________________


Dog's Name _______________________________________________

Breed          _______________________________________________

Age             _______________________________________________

Sex              _______________________________________________

Color           _______________________________________________

Medical Information

Date of last Vet Check-up          ____________

Date of DHLLP                          ____________

Date of Rabies                          ____________

Date of Heartworm check           ____________

Date next vaccinations & Heartworm check will be needed:________________

To the best of my (former owner) knowledge, this dog has no defects that would make it unsuitable as a family pet. I certify that this dog has never bitten or injured anyone.

I (adopter) understand and agree to the following terms of this contract and understand that non- compliance with the terms of this agreement gives the adopting agent/former owner the right to reclaim this dog without refund of adoption fee.

An adoption fee of $_________ will be collected at the time of adoption.

This dog shall be kept and cared for as a family pet in a humane manner and given appropriate shelter and medical care for the duration of its life.

I agree to abide by all state and local animal control and leash laws. I understand it is my responsibility to become familiar with these laws.

I understand that (former owner name here) _____________________________ makes no guarantees or warranties regarding the health or temperament of this dog. I agree to adopt this dog and to be solely responsible for this animal and any damages that may result from its actions and (former owner name here) _______________________________ shall not be held liable for the behavior of this dog or any damages it may cause. I understand that this is a binding contract enforceable by civil law.

Date of adoption: __________________

Adopter’s signature: __________________________________________

Former Owner's Signature: ____________________________________

Witness Signature: ___________________________________________