| Oldies But Goodies Cocker Rescue, Inc. |
| P.O. Box 361 • Newington, VA 22122-0361 |
| www.cockerspanielrescue.com |
| 703-533-2373 (voice mail) |
1. The Adopter shall take the animal to a veterinarian within one (1) week of the date of this contract for a check-up, medication, and treatment recommended by the veterinarian. Proof of this first veterinary visit is required. Oldies But Goodies Cocker Rescue, Inc. ("OBG") makes no representation or warranties as to the health of the dog.
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(Adopters)
Initials)
2. Since the animal comes from an
unknown genetic background, the Adopter will not hold OBG liable for any serious medical
problems such as with eyes, hips, heart, etc.
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(Adopters)
Initials)
3. If the animal
is over six months of age and has not been previously spayed/neutered, the Adopter shall
have the animal surgically sterilized within two (2) weeks of the date of this contract. If the animal is less than six (6) months of age,
I/we agree to have the animal surgically sterilized within two (2) weeks of the animal’s
turning six (6) months of age. Adoption of
the animal does not become final until the Adopter delivers proof that the animal has been
spayed or neutered to OBG. In the case of
unspayed females, if the animal produces a litter prior to spaying, the litter and the
female dog become the property of OBG. PURSUANT
TO § 3.1-796.126:2 OF THE CODE OF VIRGINIA, STERILIZATION AS PROVIDED FOR HEREIN IS
REQUIRED UNDER THE LAW, AND THE ADOPTER IS FURTHER REQUIRED TO FURNISH PROOF OF COMPLIANCE
TO OBG WITHIN SEVEN DAYS OF STERILIZATION. ANY
PERSON VIOLATING THIS SECTION OF THE CODE OF VIRGINIA IS SUBJECT TO A CIVIL PENALTY.
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(Adopters)
Initials)
4. The Adopter shall provide the
animal with humane care and maintain it in accordance with all current and future state,
county and municipal laws and ordinances where the Adopter resides.
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(Adopters)
Initials)
5. The Adopter shall provide the
animal with necessary veterinary care upon sickness, disease, injury or aging, and shall
take it to the veterinarian at least annually for a health examination and recommended
vaccinations, to include DHLPP-C and rabies as required, heartworm test and prescribed
preventative, and fecal parasite test and treatment as necessary.
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(Adopters)
Initials)
6. The Adopter shall provide the
animal with a securely fenced yard or other humane means of exercise. The animal shall not be kept constantly chained or
tied up outdoors, or allowed to run at large, nor shall it be kept outside when the
residence is unoccupied.
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(Adopters)
Initials)
7. If the animal cannot be kept by
the Adopter, the Adopter must return it to OBG. The
animal SHALL NOT be given away, sold or exchanged without the prior written permission of
OBG. In the event of the Adopter’s
death, OBG shall be notified immediately.
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(Adopters)
Initials)
8. The animal shall reside at and
live inside the Adopter’s dwelling.
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(Adopters)
Initials)
9. The Adopter shall keep the animal
as it’s own household pet, and shall not use it for breeding or exclusively as a
guard dog or hunting dog.
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(Adopters)
Initials)
10. The animal SHALL NOT be used for research.
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(Adopters)
Initials)
11. The Adopter shall provide the animal with and ensure
the use of a collar and personal identification tag for the animal to wear at all times
when allowed to go outdoors.
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(Adopters)
Initials)
12. The Adoption fee is non-refundable.
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(Adopters)
Initials)
13. The Adopter, from the date of this contract, agrees to release and indemnify OBG from any and all claims, know and unknown, now or hereafter arising in connection with the animal.
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14. The Adopter consents to the examination of the
animal by OBG at any time. The Adopter also
consents to reclamation of the animal by OBG at any time for failure to comply with the
terms of this contract or for any misrepresentation of fact made by the Adopter on the OBG
ADOPTION APPLICATION.
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(Adopters)
Initials)
15. The Adopter agrees to pay OBG for any and all
expenses, including court costs and reasonable attorney fees, in enforcing the terms and
provisions of this contract.
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(Adopters)
Initials)
16. The Adopter and OBG agree that the actual value of
this animal is $175.
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(Adopters)
Initials)
17. This contract will be governed by and construed
under the laws of the Commonwealth of Virginia without regard to conflicts of law
principals.
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(Adopters)
Initials)
18. I/we certify that we have no children under the age
of ten (10) living in my/our home.
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(Adopters)
Initials)
I/We
________________________________ (the Adopter), do this day of ____________________, enter
into this ADOPTION CONTRACT and acknowledge receipt from OBG of the custody of the animal
named and described as Name______________________________ Age____ Sex _____ (altered
____Yes ____ No) , Breed__________________ Distinguishing marks
____________________________ (the animal). I/We
acknowledge having read and agree to abide by each of the eighteen (18) Rules for Adoption
set forth herein.
Signed
______________________________________________________________________
Date
________________
Print
Name(s)
_________________________________________________________________________________________
Print
Address
_________________________________________________________________________________________
City,
State, Zip Code
___________________________________________________________________________________
Home
Phone _________________
Work
Phone______________________ email
_____________________________
Driver’s
License Number/State
___________________________________________________________________________
Witnessed:___________________________________________________________________________________________
(signed
by OBG representative, date, print name)
ADOPTION
RELEASE
Oldies
But Goodies Cocker Spaniel Rescue, Inc. (“OBG”) and its representatives ACCEPT
NO RESPONSIBILITY FOR DAMAGE OR INJURY caused by the adopted dog named below.
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(initial(s)
of adopting party)
While
every effort is made to provide accurate history and assessment of a dog, OBG and its
representatives DO NOT WARRANT THE DOG DESCRIBED BELOW REGARDING PRESENT OR FUTURE MEDICAL
CONDITION OR TEMPERAMENT.
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(initial(s)
of adopting party)
Dog Name ___________________
Distinguishing marks_______________________________
Age ___________
Sex
_________________
Color____________________________________________
________________________________________________
Signature of Adopting Party
Date
________________________________________________
Printed Name of Adopting Party
________________________________________________
Signature
of Adopting
Party
Date
________________________________________________
Printed
name of OBB
Representative
Date
_________________________________________________
Printed name of OBG Representative
Date
Signature of OBG Representative
ACKNOWLEDGEMENT
OF AND ASSUMPTION OF THE RISK FOR POTENTIAL OR ACTUAL AGGRESSIVE BEHAVIOR
The
dog described as (name) ___________________________, age _________, sex __________, may
exhibit or has exhibited aggressive tendencies as described below. Although it is possible that this dog exhibits
aggressive tendencies only in certain situations, no assurance is given.
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___________________________________________________________________________________________________________
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___________________________________________________________________________________________________________
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(initial(s)
of adopting party)
The
signature of the adopting party or parties below operates as verification by the adopting
party or parties that EACH INCIDENCE DESCRIBED ABOVE OF ACTUAL OR POTENTIAL AGGRESSIVE
BEHAVIOR BY THE ADOPTED DOG NAMED HEREIN IS KNOW AND UNDERSTOOD by the adopting party or
parties.
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(initial(s)
of adopting party)
Moreover,
the signature of the adopting party or parties below operates as verification that THE
ADOPTING PARTY OR EACH OF THE ADOPTING PARTIES VOLUNTARILY AND KNOWINGLY ASSUMES THE RISK
OF INJURY TO HIMSELF/HERSELF, HIS/HER FAMILY, AND OTHER PERSONS TO WHOM HE/SHE OWES A DUTY
RESULTING FROM SUCH BEHAVIOR BY THE ADOPTED DOG NAMED ABOVE.
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(initial(s)
of adopting party)
Finally, the signature of the adopting party or parties below operates as CONSENT TO RELIEVE OLDIES BUT GOODIES COCKER SPANIEL RESCUE, INC. AND ITS VOLUNTEERS OF ANY LIABILITY AND/OR OBLIGATION OF CONDUCT TO THE ADOPTING PARTY OR PARTIES AS RELATED TO ANY ACTUAL OR POTENTIAL AGGRESSIVE BEHAVIOR EXHIBITED HEREAFTER BY THE ADOPTED DOG NAMED ABOVE.
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(initial(s)
of adopting party)
____________________________________________
Signature of Adopting Party
Date
__________________________________
Printed Name of Adopting Party
____________________________________________
________________
Signature of Adopting Party
Date
__________________________________
Printed Name of Adopting Party
____________________________________________
________________
Signature of OBG Representative
Date
__________________________________
Printed name of OBG Representative
ADOPTION
RELEASE
The
dog described below was given up to Oldies But Goodies Cocker Spaniel Rescue, Inc. (“OBG”)
by _________________ _______________________________________________ (name of humane
society or animal shelter) WITH NO SPECIFIC HISTORY OF RELATIONSHIPS OR INTERACTION WITH
CHILDREN.
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(initial(s)
of adopting party)
In
consideration for the release of this dog for adoption by OBG, the Adopter will agree to
HOLD HARMLESS OBG AND ALL OBG REPRESENTATIVES FOR ANY FUTURE INCIDENTS WITH THIS DOG
INVOLVING CHILDREN.
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(initial(s)
of adopting party)
Dog
Name ____________________________________
Distinguishing marks
____________________________
Age ___________
Sex
_________________
Color_________________________________________
_______________________________________________________
Signature of Adopting Party
Date
_______________________________________________________
Printed Name of Adopting Party
____________________________________________ ______________
Signature of Adopting Party
Date
_________________________________
Printed Name of Adopting Party
_________________________________________________
Signature
of OBG Representative
Date
__________________________________
Printed name of OBG Representative