ILLINOIS ANIMAL RESCUE, INC.

ADOPTION AGREEMENT

For good and valuable consideration, I (we) agree to the following:

1) To adopt __________________________, Microchip # _______________________________________________,

Species ____________________, Breed ____________________________, Sex _____________, Age_______________,
Description _____________________________________________________________________________________ from
Illinois Animal Rescue, Inc. on ______________ for a NON-REFUNDABLE donation to the organization of ____________.

2) To take the adopted animal to a veterinarian for an overall wellness exam within 72 hours of adopting him/her; to notify
Illinois Animal Rescue, Inc. of any found contagious condition.

3) To be responsible for and payment for, any medical costs, veterinary care, procedures, vaccines, etc. associated with
the adopted animal, regardless of cause or circumstance, from the moment they leave Illinois Animal Rescue’s care to the
end of their natural life; to keep the animal current on vet and state required and recommended vaccinations. Dogs are to be
kept on heartworm preventative. If I am unwilling or unable to pay for these expenses, or unable/unwilling to comply with
what is in the best interest of the adopted animal, I will notify Illinois Animal Rescue, Inc.

4) To not euthanize the adopted animal without first contacting and receiving express permission from Illinois Animal
Rescue, or the by the recommendation of a licensed veterinarian, due to untreatable medical conditions or to relieve
suffering.

5) To keep the animal contained in accordance with the law, have proper identification at all times, keep the animal as an
indoor pet only, and never leave the adopted animal outside unattended.

6) To allow representatives of Illinois Animal Rescue, Inc. to visit my home to determine if the care of the animal is proper.
In the event that the board of directors deems, in accordance with The Human Care for Animals Act and Illinois Animal
Rescue, Inc. bylaws, that the care of the adopted animal is not proper or accommodating, I will immediately give up my
rights to the adopted animal and relinquish him/her to Illinois Animal Rescue, Inc.

7) To maintain all of my right, title, or interest in said adopted animal and not assign or transfer any of my right, title or
interest in and to the adopted animal to anyone other than Illinois Animal Rescue, Inc.

8) All efforts are made to ensure that all animals adopted from Illinois Animal Rescue, Inc. have been spayed or neutered.
In the case, that this has not been done due to any extenuating circumstances, I agree that the animal I am adopting will be
spayed or neutered by _______________.

9) To give up my right to the adopted animal in the event that he/she is placed with, or is in, any animal welfare facility,
humane society, or like facility for the care of abandoned animals.

10) To contact the local animal control facility, local police department and Illinois Animal Rescue, Inc. immediately if the
adopted animal is lost or missing, make a thorough effort to locate and retrieve the animal, and to contact Illinois Animal
Rescue, Inc when the adopted animal is found.

11) To pay all expenses and reimburse Illinois Animal Rescue, Inc. in the event that Illinois Animal Rescue, Inc. incurs any
costs or expenses as a result of my failure to comply with the terms of this agreement or any costs or damages incurred by
the animal, including attorney’s fees, court costs and $500 to Illinois Animal Rescue, Inc. if I fail to comply with the terms of
this agreement.

ILLINOIS ANIMAL RESCUE, INC. 847.493.7200 1

ILLINOIS ANIMAL RESCUE, INC.
12) To relinquish the adopted animal only and to pay $500 to Illinois Animal Rescue, Inc. if I breach any terms or conditions
of this agreement.

13) To allow the adopted animal a proper period of adjustment time of at least two weeks without excess stimuli (i.e.
Introducing to dogs or people who are not a part of the household); to keep the environment as quiet as possible for the
adopted animal for said period of time; to not leave adopted pets unattended with elderly, young children or pets.

14) To relinquish the adopted animal to Illinois Animal Rescue, Inc. in the event that my veterinary or personal references
do not meet the standards of Illinois Animal Rescue, Inc.

Last name(s) ______________________________________ First Name(s) _____________________________________

Address _______________________________________ City, State, Zip _______________________________________

Phone 1 ___________________________ Phone 2 __________________________ DL# __________________________

Email address ______________________________________________________________________________________

________________________________________________________________ __________________________
SIGNATURE OF ADOPTER(S) DATE

Adoption Health Waiver

Illinois Animal Rescue has observed the following medical conditions in this animal:
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________

This animal has or has not been seen by a veterinarian for these concerns. If you would like to adopt the animal, please schedule an appointment
with your veterinarian within _______________ days.

As the adopter, you assume all financial responsibility for any further medical expenses the animal requires.

Adopter’s veterinarian: ___________________________________

Date and time of appointment: _____________________________

Adopter’s signature: _____________________________________

Date: _________________________________________________

Thank you for adopting this very special pet!

ILLINOIS ANIMAL RESCUE, INC. 847.493.7200 2