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Promised Land Animal Rescue Adoption Contract 1611 Rocky Hollow Road Atkins, VA 24311 276-686-8522 Name:____________________________________ Home phone: _________________________ Address: _________________________________ Work phone: _________________________ _________________________________________ E-mail address: _______________________ Driver’s license/ I.D. number: _______________ Adoption date: _______________ Adopted animal: Cat Dog Horse Name: _______________________
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I, the undersigned, agree to do the following:
1. To provide all proper and necessary care and treatment for the animal I have adopted from Promised Land Animal Rescue (PLAR), including, but not limited to, shelter in my home, humane treatment and veterinary care. I promise and agree that the animal shall be returned by me to PLAR if I am unable or neglect to provide all proper and necessary care and treatment. If the animal is removed from my home or otherwise confiscated by a third party, including, but not limited to, the police or county animal welfare agency, because I have failed or neglected to provide all proper and necessary care and treatment, I understand and agree that PLAR may direct the third party to return the animal directly to PLAR, at which time PLAR shall have sole discretion to determine the proper disposition for the animal. ___
2. I am 20 years of age or older and I am adopting this animal as my own companion animal, I will not give him/her as a gift, or resell this animal, or use him/her for experimental purposes. I also agree to return the animal to PLAR in the event I can no longer care for this animal. ___
3. If the animal being adopted has not yet reached the appropriate age to be sterilized, I agree to have the surgery performed before the age of 6 months and to provide proof of the procedure to PLAR. ___
4. To maintain the animals’ inoculations against rabies and to have the animal licensed according to State Law.___
5. To abide by all State Laws and Municipal Ordinances controlling animals. ___
6. PLAR does not reimburse for outside veterinary bills. ___
7. I understand that the processing fee is non refundable for any reason. ___
8. I understand and agree that PLAR makes no express or implied warranty, representation or promise as to the age, health, breed, habits, disposition or safety of the animal. I do hereby, fully and forever release, acquit and discharge PLAR and its officers, directors, employees, members, insurers and agents ( collectively the “Released Parties”), from any and all manner of action and actions, suits, debts, claims, liabilities, controversies, damages, costs, expenses, attorneys’ fees, and demands of any nature whatsoever, whether compensatory or punitive in nature, including, but not limited to, any liability for personal injury or property damage caused by the animal to another animal or person, illness to the animal, or illness or parasite transmitted by the animal to another animal or person. I further promise and agree to indemnify the Released Parties against any and all liability incurred by the Released Parties, including, but not limited to, all judgments, settlements, penalties, forfeitures, fines, costs, expenses and actual attorneys’ fees, that arise out of or relate to my adoption or ownership of the animal. ___
9. I understand that I am adopting this animal with the following diagnosed condition or fault, and I realize that this animal my need further training or treatment________________________________________________________
10. I hereby swear and affirm that I have never been convicted of animal cruelty, neglect, or abandonment. I also acknowledge by my signature, that I have read and agree to this statement.
Adopter’s Signature: __________________________________ Date: _________________________________
PLAR Representative Signature: _______________________________________________________________ Adoption Fee: _____________________ Donation: ________________________________________________
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