Date of Adoption:
Adoption fee:
Dog's Name:
Age:
Sex:
Color:

Medical Information:
Sterilized:
Heartworm Test:
DHLPP:
Rabies:
Other:

Heartworm prevention (Ivermectin) has been given on the 1st of every month so this dog needs the next dose on _________. Booster vaccinations are due __________________.

Please initial the following:
_____This dog must be maintained on heartworm prevention, yearly vaccinations, flea and tick prevention, and proper coat care. I will provide regular veterinary care for the duration of the dog's life.
_____ If at any time I am unable to keep or properly care for this dog I will return this dog to West Texas Chow Chow Rescue. I will not abandon this animal or take it to an animal shelter, pound, or humane society. I will not give away this dog.
_____ I will keep this dog as a family pet and care for it with affection and kindness.
_____ I will notify West Texas Chow Chow Rescue if this pet is lost or stolen, and will make every effort to locate and recover the dog.
_____ I understand that the phone lines at West Texas Chow Chow Rescue are always open. We like to hear from our adopters and we like to know how things are going. If you have any problems or questions, please call. If you need help with your dog, please call. If you experience any behavior problems with your dog, let us know.

I agree that by adopting this dog I am to be solely responsible for this animal and to indemnify and hold West Texas Chow Chow Rescue or any representative thereof, harmless from any and all claims of liability for the conduct of this dog on and after the date of this adoption. I further agree and intend that this release of liability and indemnification shall apply to all known, unknown and unanticipated damages resulting from my adoption, ownership and control of such animal.

I have read this contract before signing and agree to all conditions listed therein. This is a binding contract enforceable by civil law.

Adopter's Name:
Address:
Phone Number:
Signature:

Rescue Volunteer:

West Texas Chow Chow Rescue
1850 State Road 2130
Lubbock, TX 79407
Phone (806) 234-2230
Fax (806) 234-2304
Email adoptachow@aol.com

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