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Adoption Agreement - Tel.: 715-222-4848
Great Dane Rescue of MN, WI and NW Illinois 8238 Waldora Road Siren, Wisconsin 54872 USA gdromn@gmail.com www.gdromn.com
Date:_____________ Name:______________________________ Address:____________________________ City:__________________State___Zip____ Email:_______________________________
Phone:______________________________
Dane Name_________________________________
Adoption Agreement
GREAT DANE RESCUE OF MN AND WI
715-222-4848
gdromn@gmail.com
http://www.gdromn.org/
Great Dane Rescue of MN, WI and NW Illinois herein known as GDROMN, is a non-profit volunteer organization working to re home Great Danes. Our primary purpose is to find appropriate, loving, permanent homes for Danes who might otherwise suffer abuse, neglect or death.
I (we), the Adopter(s) agree to the following:
RELEASE AND INDEMNITY AGREEMENT
IN CONSIDERATION of the adoption fee in the sum of ___________________Dollars
( $______), the receipt of which is hereby acknowledged, the undersigned Adopter(s) do hereby forever release, discharge and covenant to hold harmless GDROMN and any other person, firm or corporation charged or potentially chargeable with responsibility or liability, their agents, heirs, administrators, executors, successors and assigns, from any and all claims, damages, costs, expenses, loss of services, actions and causes of action, suits, claims, damages, judgments, whether known or unknown, in law or in equity, that
we the Adopter(s) had, have or may have arising out of any act or occurrence relating to or flowing from the adoption of: _________________
The Adopter(s) hereby declare(s):
1. That Adopter(s) understand(s) and agree(s) that GDROMN disclaims any and all statements, opinions, representations or express or implied warranties (whether written, electronic or oral) concerning the background, past or future temperament, breeding, behavior or health condition of said dog, and any representations regarding the nature and extent of legal liability or financial responsibility any representative of GDROMN may have made that may have induced the Adopter(s) to make this Release and Indemnity Agreement; and
2. That in determining the amount of the said Fee, there has been taken into consideration age, health, veterinarian services and care of the said dog, up to the present time.
THE UNDERSIGNED hereby further agrees to abide by the following TERMS OF ADOPTION:
1. Sterilization. The said dog must be neutered or spayed. Adopter agrees that under no circumstances will this dog be used for breeding purposes. If this dog has not been sterilized by GDROMN prior to adoption the Adopter agrees to have the dog spayed or neutered as soon as the dog's health is appropriate for spay/neuter. A refundable deposit is required at the time of adoption of an unsterilized dog, in the amount of Three Hundred Dollars ($300.00). A copy of the veterinary invoice showing the sterilization of the dog must be forwarded to GDROMN along with a request for return of the deposit. If you wish to make the deposit a donation to GDROMN please state so and a tax deductible receipt will be sent to you. Failure to contact GDROMN with the sterilization paperwork will result in the dog being removed from Adopters custody by GDROMN.
2. Return. If for any reason, the adoption is not satisfactory to the adopting party or if the Adopter(s) fail(s) to comply with all the terms and conditions of the Agreement, the dog must be returned to GDROMN. If the dog is returned to GDROMN within fourteen days from the date of adoption, GDROMN will refund the Adoption Fee.
3. Transfer of Ownership. The dog may not be transferred to any other person, firm or corporation for any reason whatsoever. GDROMN must be notified upon the death of said rescue dog. Adopter agrees to contact GDROMN if the dog is lost for more than 12 hours. GDROMN will accept return of said dog at any time and for any reason. Adopter must call GDROMN at 715-222-4848 to make arrangements for the dogs return.
4. Surrender. Adopter(s) agrees to return the dog to GDROMN if the Adopter(s) does not want or can no longer take care of the animal. Initial here _____.
5. Care. It is understood that this dog will be kept as a house dog, not a kennel or yard dog and that the dog will not be kept chained or on a tie-out at any time. The primary function of the dog is that of a pet and companion. The dog must never be allowed to roam free in an unfenced area without supervision.
The dog must be placed on a vaccination and heartworm prevention program as established by the Adopter's veterinarian in order to guarantee the continued health of the dog. The dog must receive regular Rabies vaccination or titers and any others that are required by law. The Adopter assumes all responsibility for said dog including but not limited to food bills, health care and general well being. The dog must wear an identification tag as well as a rabies tag. Adopter agrees to allow GDROMN to periodically check the dog’s acceptance of the new environment and family and to ensure the Adopter's compliance with the Terms of Adoption.
6. Reservation of Rights: GDROMN retains the right to reclaim said dog when there is probable cause to believe abuse, neglect, inadequate care or treatment has occurred, or a breach of the Terms of Adoption has occurred. The Adopter(s) agree(s) to relinquish custody of said dog to a member of GDROMN immediately upon demand without legal writ or court order. Within 10 days of the reclamation, if the situation warranting the reclamation is rectified to the satisfaction of the GDROMN Board of Directors, upon majority vote, the dog will be conditionally returned to the owners. If the situation warranting the reclamation has not been rectified, or cannot be rectified, or there is no reasonable probability that the situation will be rectified within another 10 days, then all right, title and interest in the dog shall be deemed transferred to GDROMN for the dog to be re-homed. If the Adopter contests this decision, the Adopter must file a demand for mediation or alternative dispute resolution. The party requesting mediation shall bear the cost of the mediator's services. The Adopter may voluntarily surrender the dog for placement by GDROMN at any time. GDROMN retains the right to all photos and stories sent to them by the adopter or photos taken at the time of adoption by GDROMN. Adopter understands these items may be used in printed form or on the internet by GDROMN with no remuneration to the Adopter.
7. Attorney Fees and Costs. Should it become necessary for GDROMN to take legal action to recover the adopted dog or otherwise enforce the provisions of the Agreement, the Undersigned Adopter(s) agree to pay all court costs and reasonable attorney's fees.
8. Waiver and Mutual Release. In consideration for this adoption transaction, Adopters, their estate, successors and heirs do hereby absolutely, unconditionally, and irrevocably release and forever discharge GDROMN from and against any and all actions, causes of action, proceedings, suits, debts, claims, counterclaims, damages, judgments, and executions, whether liquidated or not liquidated, absolute or contingent, known or unknown, suspected or unsuspected, at law or in equity, that relate to the adopted dog listed above, including but not limited to, its behavior, temperament, physical health, actions, damage, or destruction of person or property. Adopters agree to assume full and sole liability from this date forward for said dog and its actions, and Adopters acknowledge that they do so being fully advised about any identified issues known to GDROMN.
GDROMN AND ITS REPRESENTATIVES ACCEPT NO RESPONSIBILITY FOR DAMAGE OR INJURY CAUSED BY THIS DOG AND MAKE NO GUARANTEE AS TO ITS PRESENT OR FUTURE MEDICAL CONDITION OR TEMPERAMENT.
9. Affirmation .The Adopter(s) affirms that he/she is adopting said DOG as a companion animal and agrees to abide by the terms of the Agreement. By signing, the Adopter is stating that each clause and the contract in its entirety has been read and understood by him/her. The Adopter is signing of his/her own free will and not under duress of any kind. Adopter affirms that he/she has never been charged with animal cruelty, and is not and animal dealer or broker. All of the information provided to GDROMN by the Adopter(s) is correct and complete.
Date:_________
Adopter(s) Name:_____________________Signature:_________________________
Adopter(s) Spouse:__________________ Signature:_________________________
AGENT:____________________________Signature:_________________________
Acknowledged receipt of an additional donation in the amount of $__________
Acknowledge receipt of adoption fee in the amount of $___________
Agent’s initials____________
As the owner/guardian of this animal I authorize the release of all medical data in PetPoint relating to the animal upon electronic request by any treating veterinarian.