Pet Adoption Agreement
Pet’s Name: ________________ Description: __________________
Sex: ____ Age: _________ Altered:______
Date to be altered ____________
Adopter’s Name(s): _____________________________________
State: _____________ Zip: __________
Home Phone: _______________________
Work Phone: ________________________
As the adopting party, I/We agree to the following provisions: (initial each)
_____1. I/We agree to keep said pet licensed in my county. I understand that by keeping tags on my pet that it will insure my pet a safe return if he happens to get lost. I will contact Kaye Smith or Christa Medders if my animal becomes lost.
_____2. I/We agree to keep my pet up to date on his shots, as prescribed by my vet. I will provide immediate medical care if my pet becomes injured or sick.
_____3. I/We agree to keep the animal I am adopting as a house pet. I will provide proper shelter in the heat and cold, if the pet is outside for any length of time.
_____4. I/We agree not to let my adopted pet run at large, or become a nuisance.
_____5. I/We agree not to abuse or neglect the adopted animal, and I authorize Kaye Smith or Christa Medders, at her sole discretion, to determine whether of not the pet has been abused or neglected.
_____6. I/We understand that Kaye Smith or Christa Medders cannot guarantee the health, temperament or training of the above described animal, and hereby release Kaye Smith and Christa Medders from any claim, cause of action or liability for any Injury or damage to persons or property once the animal is in my possession. If a health problem develops I will notify Kaye Smith or Christa Medders to discuss the matter.
_____7. I/We agree that if Kaye Smith or Christa Medders should determine at any time that any of the provisions of this agreement are not being complied with, I will return the pet to Kaye Smith or Christa Medders upon demand.
_____ 8. I/We agree that Kaye Smith, Christa Medders and Small Time Dog Rescue/Dead Dog Walking Pit Bull Rescue are not responsible legally, medically or in any way for any harm that may happen to or be caused by the pet I am adopting. This includes harm caused by or to visitors/relatives in my home.
_____9. I/We agree that said dog will not be used for any illegal purposes and will NEVER be fought in any way. If this clause is broken, I/We understand that the dog will be immediately confiscated by Kaye Smith, Barry Springer and/or Christa Medders and all law enforcement agencies will be notified, as applicable.
_____10. I/We certify that we do not live in an area where "Pit Bulls" are banned.
_____11. I/We have enrolled this pet for obedience training at _______________________________
which will be started on the following date: _________________________
Animal Return: I understand that if I am not able to keep the pet for its natural lifetime, I will contact ___ or ____. Kaye Smith and Christa Medders have first right of refusal. I will not give the adopted pet away without first contacting Kaye Smith or Christa Medders. I will not euthanize the pet without first contacting Kaye Smith or Christa Medders.
There are No refunds.
Signature of adopter(s): __________________________ _________________________
Date: ____________ Donation: $_________
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