ADOPTION AGREEMENT

Name________________________________ Home Phone ____________________

Address _____________________________ Work Phone _____________________

City ___________ State ______ Zip Code ______ Cell Phone __________________

I, ____________________________________________, agree to adopt the animal described below from the current

custodian, on this day _______________________________, 20________ for the adoption fee of $______________.

(Refundable within 14 days)

Animal Name: ________________________________ Sex: M / F Microchip #: _______________________

Vets. Name: ______________________________________ Vets. Phone Number: _______________________

Chow Chow Rescue of Northern California agrees to the following:

To give adopter possession of _____________________ as long as they comply with the terms of this contract.

To give a two week trial period. Chow may be returned for a full refund or may be reclaimed by us if an on-sight inspection by a member does not show the home to have adequate security or show proper welfare for the dog.

As adopter, I agree to the following:

To provide a safe, clean environment with securely fenced yard and assume all responsibility for dog’s well-being, keeping shots current and adequate vet. Care.

Allow a member to inspect the home, usually during trial period if we feel it necessary and practical.

To notify Chow Rescue within 24-hours if dog escapes and is not recovered immediately. Dog must have current license. It is also advisable to leave our tag on as an extra I.D.

Return the Chow to rescue if you are no longer able to keep or your situation changes and dog becomes a burden. Under no circumstances will I sell, give away or abandon this dog.

I am aware that animals are different than people in their responses to human actions; that the actions of animals are often unpredictable and Chow Rescue makes no representation as to the temperament or behavior of the dogs put up for adoption. I accept possession of this animal at my own risk and release Chow Chow Rescue of Northern California of any damages to person or property that may be caused by this dog in the future.

Please make checks payable to: Prudence Baxter

I declare that all of the information I have given above is true and complete. I understand that by signing this agreement that I am bound to the terms of this agreement and that Chow Chow Rescue of Northern California provides no medical/behavior assurances whatsoever.

Signature _____________________ Print Name ____________________ Date ________________

Chow Chow Rescue of Northern California (530) 885-0963

norcalchowrescue.com norcalchowrescue@yahoo.com