Office Use Only Adoption Contract This form may be filled out on line and then printed out You may mail this form co by lonyoo

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									Office Use Only: _____________________________|___________________________|___________________

Adoption Contract
This form may be filled out on line and then printed out. You may mail this form complete to: PNWJRTN Rescue c/o Rescue Coordinator P O Box 6184 Bellevue, WA 98008-0184 206-749-9087 Please Print: Name: ___________________________________________ Date:_________________ Address: ________________________________________________________________ ________________________________________________________________________ Home Phone: _________________________________________ Evening Phone: _____________________________________ Best time to call: _____________________ E-mail: __________________________________________ I, _______________________, the undersigned (hereinafter referred to as ADOPTER), Agree to the conditions set forth by the Pacific Northwest Jack Russell Terrier Network Rescue, (hereinafter referred to as AGENT) in this agreement for the adoption of the dog known as _____________________, described as _________________ a Jack Russell Terrier (hereinafter referred to as TERRIER). The ADOPTER agrees to provide adequate shelter, food and all necessary medical care and further agrees that the rescued terrier will not be allowed to run free without direct and proper supervision. Failure to do so will require that the

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TERRIER be surrendered to the Pacific Northwest Jack Russell Terrier Network Rescue Agent. As of ________________ (date), the ADOPTER, as the new owner accepts the responsibility for the actions and behaviors of the above-described dog, releasing previous owners and/or agents from all liability, and acknowledges and agrees to the following conditions of adoption: • The TERRIER must be given adequate time to adjust to its new surroundings and its new owners. • The Pacific Northwest Jack Russell Terrier Network Rescue Agent will be contacted immediately for assistance and/or counseling if any problem(s) should arise. • If for any reason, the adoption is not found to be satisfactory for the TERRIER and/or the ADOPTER, the TERRIER must be returned to the Pacific Northwest Jack Russell Terrier Network Rescue Agent. • The ADOPTER may not sell or give the TERRIER away to anyone else. • Periodic follow-up telephone calls will be made by the Agent to be assured of to all terms of the agreement. • The Agent reserves the right to inspect the conditions and care of the TERRIER at any future date and reserves the right to confiscate said TERRIER if neglected or otherwise improperly cared for. No refund of any adoption fee will be made for confiscated terriers.  REFUNDS of adoption fees less a twenty percent office charge will be made in the case of TERRIERS returned to the Pacific Northwest Jack Russell Network Rescue within 30 days of adoption due to unforeseen circumstances or because of incompatibility. No refunds will be made after 30 days without the approval of the board of directors.

The adoption fee is $________. This fee is used to cover rescue expenses, including foster care costs and veterinary bills incurred by PNWJRTN Rescue. The rescued terrier has been examined by a veterinarian where indicated, received any necessary inoculations, and been de-wormed as necessary. All rescue terriers are spayed or neutered, if of age to have such procedures preformed, before placement in the ADOPTER'S home. The AGENT will provide all documents pertaining to the TERRIER, including any JRTCA registration papers, or per recording papers and any veterinarian records, to the ADOPTER.

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Additional information about the TERRIER: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Specifically, the ADOPTER agrees to: 1. Provide proper and sufficient food, water, shelter and kind treatment for the terrier at all times. 2. License the terrier in the city or town in which the ADOPTER resides. 3. Have the terrier spayed or neutered, if immature at the time of the adoption. The ADOPTER understands that failure to do so will result in forfeiture of deposit and, upon demand, return of the terrier to the PNWJRTN Rescue Agent. 4. Not sell or abandon the terrier. 5. Return the terrier to the PNWJRTN Rescue Agent if for any reason the adoption is found to be unsatisfactory. 6. Allow periodic inspections of the terrier, the ADOPTER'S residence and the living conditions provided for the terrier by the PNWJRTN Rescue Agent. 7. Inform the PNWJRTN Rescue Agent of any address and/or telephone number change. 8. Not allow the terrier to be used for the purpose of vivisection or experimentation. 9. Not permit the terrier to run at large or to become a public nuisance. 10. Keep means of identification on the terrier at all times. 11. Immediately retrieve the terrier from any public pound or animal shelter when notified the terrier is being held at such location.

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12. Notify the PNWJRTN Rescue Agent immediately if the terrier is lost, stolen or dies. 13. Provided suitable confinement for the terrier. Under no circumstances is the animal to be routinely tethered as a means of confinement. 14. Keep the animal protected on a leash when outside proper confinement. 15. Arrange for suitable care if the owner will be on a prolonged absence from the home. 16. Assert no claim, charge or demand of any kind against PNJRTN Rescue or its Agent for any expenses that have been incurred by the ADOPTER, including veterinary fees, in connection with the animal. 17. Accept sole responsibility for any illness or injury occurring after adoption. 18. Accept this terrier as is, assume all risk of ownership of the terrier, including risk of injury or damage caused by the terrier, including bites. I FULLY AND COMPLETELY RELEASE PNWJRTN RESCUE AND ITS AGENT HARMLESS FROM ANY CLAIM, CAUSE OF ACTION OR DEMAND OF ANY SORT OR NATURE AS A RESULT OF MY ADOPTION, OWNERSHIP, CARE, MAINTENANCE OR RETENTION OF THE TERRIER. I ACKNOWLEDGE THAT I HAVE READ AND FULLY UNDERSTAND THE TERMS AND CONDITIONS OF THE FOREGOING ADOPTION AGREEMENT AND THAT I WILL COMPLY WITH THE SAME. Signature:______________________________________ Date:___________________________ Printed Name:___________________________________ Rescue Administrator's Signature:_______________________________________________

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