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Contact: Jackie Cullen Provided on Real Form Clarksville, PA 15322 Phone: Provided on Real Form

DOG ADOPTION CONTRACT


PET INFORMATION

ADOPTER INFORMATION
Name: __________________________________________ Street Address: ___________________________________ City: _______________ State:________ Zip: __________ Home Phone: ______________ Cell Phone: ____________ Email address: ___________________________________ Payment: Cash Check (Check #______) PayPal NONE Donation $_________ Adoption Fee $_____________

Name: __________________________________ Diesel Female Spayed Neutered X Male Breed: Ambully/GSD ______________ ____________ Mix Color: Brown Approx. Age: ________ 8 months ___Rabies #: ___________ Microchip #: ________________________

FOSTER RESPONSIBILITIES

jacquelynecullen@gmail.com Jackie Cullen Name of Contact Person: ______________________ Phone: ____ Email: _________________________________ Jacquelyne Cullen agrees to provide a dog that has been tested for heartworm disease, provided heartworm preventative medication, vaccinated for rabies and distemper/parvo, neutered, and microchipped. Proof of vet work will be provided to adopter during transfer of ownership. Adopter will be informed of any known history of medical or behavioral issues. Vaccinations are required every 1-3 years. Please follow your veterinarians recommendations. Any booster shots required after the date of adoption are the financial responsibility of the adopter. Jacquelyne Cullen has committed to the health, safety, and wellbeing of this dog for its lifetime. She will provide training counseling free of charge at any time upon request. Any future supplies required/desired after the date of adoption (such as training collars, flirt poles, crates, sports classes, etc) are the financial responsibility of the adopter. Jacquelyne Cullen also agrees to accept the dog back at anytime for any reason that the owner no longer wishes to provide care for the dog but is not responsible for transport. _______ Initials
ADOPTER RESPONSIBILITIES I, the adopter, agree to the following terms and provisions: 1. If this dog does not adapt to my home or I cannot keep the dog for any reason, or if I intend to euthanize the dog for a treatable medical or behavioral issue, I will contact Jacquelyne Cullen to offer the animal back to his foster mother before relinquishing custody or possession of the animal to anyone else or prior to euthanizing the animal. _______ Initials 2. From the date of this contract, I agree to assume full responsibility for the veterinary care for this dog, including an annual examination and routine vaccinations and tests. I will keep the dog free of pests and parasites, including ticks and fleas. I understand that dogs require monthly medication for heartworm prevention and agree to provide this medication for the life of the dog _______ Initials 3. I will provide this dog with proper containment. This dog will be kept on a leash at all times when outside of a securely fenced-in area. I agree to have my dog legally licensed in my county of residence within 7 days of date of adoption. _______ Initials 4. I will not leave the dog in an electronic containment system unsupervised. I will not allow this dog to live primarily outside, in a basement, garage, screened in porch, or any area other than the main living quarters. _______ Initials 5. I will provide a collar for the dog to wear at all times, and the collar will have an ID tag with current contact information, current county license, microchip tag, and rabies tag affixed to the collar at all times. _______ Initials 6. I will keep the dogs microchip registration up to date, and will notify the microchip company of any change of contact information. _______Initials 7. I agree to not abuse or neglect the dog. I will consult with Jacquelyne Cullen, my veterinarian or a trainer about the appropriate ways to deal with specific behavior problems rather than abuse or neglect my dog. ______ Initials 8. I consent to the examination of this dog by Jacquelyne Cullen at any time in the future and acknowledge that Jacquelyne Cullen has the right to reclaim this dog at any time for failure to comply with the terms of this contract or for any misrepresentation of fact made on the adoption application or in this contract. I agree to provide periodic updates on the dog to Jacquelyne Cullen. _______ Initials 9. I have been counseled on the possibility due to genetics of any bully breed becoming dog aggressive. I agree not to set my dog up to fail by taking it to off-leash dog areas such as dog parks and doggy daycares. I understand if my dog does become dog aggressive, I can manage it responsibly by crating and rotating the dogs in my home. I agree to have break sticks in the home and to have one with me at all times when in public with my dog. I understand dog aggression is genetic and can be managed but not trained out. ________ Initials Adopter (Sign): ________________________________ Adopter (Print): ___________________________________ Date: _______________ Foster (Sign): ________________________________ Foster (Print): ___________________________________ Date: _______________
Commonwealth of Pennsylvania County of On this, the________day of __________, 20____, before me a notary public, the undersigned officer, personally appeared________________, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. In witness hereof, I hereunto set my hand and official seal. ___________________________ Notary Public

10. I agree never to leave my dog unsupervised around children. ______ Initials 11. I understand that this is a legal and binding contract and by my signature agree to all of the terms herein. _______ Initials 12. I confirm that all information given in this contract is correct and accurate. I also understand that once the contract is signed and I have taken possession of the animal, I will be solely responsible for any actions of this animal, and I agree to hold harmless the foster parent from any liabilities, injuries or loss caused by this animal or any causes of actions, claims, suits or demands that arise from such injury, damages or losses. In the event the terms of this contract are breached, I, as the Guardian of this pet, shall owe the foster parent the sum of five hundred dollars for liquidated damages, and will be responsible for all attorneys fees and court costs involved, as well as returning the animal to the foster parent. ________Initials

Diesel was returned to foster care 2/8/14 by his 1st adoptive family after having bitten a child who Additional comments/conditions: ______________________________________________________________________________________ hugged him while eating a bone. There is no other aggression reported. Diesel has been vetted for behavioral issues. His reason for return to __________________________________________________________________________________________________________________ foster was not unsolicited aggression but instead the result of a child left unsupervised with a dog who had a high value food item. Therefore, __________________________________________________________________________________________________________________ he is deemed safe for adoption to an adult only home. Diesel has a fear tendency in new areas. He may shiver and cower when first __________________________________________________________________________________________________________________ approaching a new building. Patience and reassurance is needed to give him confidence. Diesel's first home rarely needed to leave him __________________________________________________________________________________________________________________ alone, and he became accustomed to constant human companionship. Thus, he should not be left alone for long periods of time. Adopter __________________________________________________________________________________________________________________ made aware and assumes responsible pet ownership of Diesel to ensure he has a safe environment. Foster recommends daily adequate mind__________________________________________________________________________________________________________________ stimulating physical activity (such as flirt pole, fetch, spring pole, nosework, etc), NILIF (nothing in life is free) training, a 2 week shutdown __________________________________________________________________________________________________________________ from date of adoption, high quality food, and annual veterinary visits. He is due for his next vet appointment 2/20/15. (Information on __________________________________________________________________________________________________________________ activity suggestions, NILIF, 2 week shutdown, and nutrition suggestions provided at transfer of ownership.) _________________________________________________________________________________________________________ Adopter (Sign): ________________________________ Adopter (Print): ___________________________________ Date: _______________ Foster (Sign): ________________________________ Foster (Print): ___________________________________ Date: _______________
Commonwealth of Pennsylvania County of On this, the________day of __________, 20____, before me a notary public, the undersigned officer, personally appeared________________, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. In witness hereof, I hereunto set my hand and official seal. ___________________________ Notary Public

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