Adopter's Name _______________________________________________
Adopter’s Phone _______________________________________________
Adopter’s Address _______________________________________________
Former Owner's Name ____________________________________________
Former Owner’s Phone ____________________________________________
Former Owner’s Address ____________________________________________
Dog's Name _______________________________________________
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: ___________________________________________