First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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Email*

Home Phone*

Cell Phone*

Name of dog being adopted*

TERMS The Adopting Party and Adopting Agency (“NASRN) understand and agree to the following terms and policies: NASRN has provided to the Adopting Party all available information pertaining to this dog and is not responsible, nor liable for any unknown or unavailable information concerning health, habits, temperament, or past treatment of this dog. The Adopting Party agrees that it is the Adopting Party’s responsibility to personally assess this dog and its suitability for the Adopting Party’s needs. By agreeing to this contract, the Adopting Party certify that the Adopting

If this dog is under the age of six (6) months old, I agree to have the dog spayed or neutered when it reaches the age no more than 12 months old. I agree to provide proof of spay/neuter to NASRN. If I wish to adopt this dog after spay/neuter surgery, I agree to pay for the cost of surgery in lieu of an adoption fee.

The adopting party recognizes and agrees that adoption fees are non-refundable.

The Adopting Party agrees that, should your dog bite a person, the adopting party is solely and exclusively responsible, both legally and financially for any damages incurred. The Adopting Party agrees that NASRN will not be held responsible, neither legally or financially, for any damages incurred as the result of a bite incident.

The Adopting Party agrees to license this dog with the appropriate agency if required by law governing the Adopting Party’s residence.

The Adopting Party agrees to give regular health care, including annual health checks, immunizations and boosters,heartworm preventative, and any necessary medical care and further agree that the Adopting Party has current sufficient financial ability to do so.

The Adopting Party agrees to provide adequate fencing – adjacent to and accessible from my home – sufficient to ensure the dog’s safety.

The Adopting Party agrees to provide adequate protection from excessive heat and cold; refrain from chaining or tying the dog outdoors; and by always walking the dog on leash when away from the Adopting Party’s home, if not in a contained, safe environment.

The Adopting Party agrees that the dog may not be sold, given away, or placed or abandoned in an Animal Shelter without written permission of NASRN. This dog may not be euthanized without the written permission of NASRN,unless it is medically necessary to prevent undue pain and suffering by the dog as determined by a veterinarian.

The Adopting Party agrees that NASRN can require the return of this dog to NASRN, the transport of which will be arranged by NASRN at NASRN expense, if the Adopting Party violates any terms of this agreement. If the Adopting Party fails to honor the terms of the agreement, this agreement becomes null and void and NASRN retains the right to reclaim and take possession and ownership of the dog.

The Adopting Party agrees and recognizes that NASRN will not accept the return of your dog should the dog bite a person.

The Adopting Party agrees to contact NASRN at the above address or email if the Adopting Party can no longer keep this dog. The Adopting Party agrees to make arrangements for the proper care of this dog for a minimum of two weeks after providing notice to NASRN, while arrangements are made by NASRN, at NASRN expense, to rehome this dog.

The Adopting Party agrees to contact NASRN at the above address or email if the Adopting Party cannot keep this dog for any reason. If this dog was transported long distance by NASRN volunteers, the Adopting Party agrees that they will be responsible for providing transportation for this dog to return it to previous foster or new foster home.

During a 30-day probationary period from the date of transfer of the dog, either the Adopting Party or NASRN may cancel this agreement for any reason.

The Adopting Party agrees that a designated NASRN representative may visit the Adopting Party’s home and property to check on the welfare of this dog if NASRN has good reason to believe that the Adopting Party is violating a term of this agreement.

In consideration of NASRN allowing the Adopting Party to adopt this dog, the Adopting Party promise and agree to be solely responsible for this animal and to indemnify and hold harmless NASRN, its Board of Directors, Officers, Agents, Members, and Volunteers from any and all claims of liability for the health or arising from the conduct of the dog on and after the date on which the Adopting Party takes possession of the dog.