SCLRR as an organization and its volunteers as individuals freely invest considerable time, money, and physical and emotional energy in each of our dogs. We do this out of our deep concern for their welfare. That's why we list the conditions we believe are necessary to provide them with safe, permanent, happy homes and ask that you agree to them. We want your dog to have the best possible chance at life and for you and your family to have a long and rewarding relationship with this new member of the household.
I, the undersigned adopter, do hereby release and covenant to
hold harmless Southern California Labrador Retriever Rescue, Inc.
(SCLRR) and its volunteers from any claims, damages, costs or actions
incurred as a result of this adoption or caused by the actions of
the dog transferred herein. Moreover, I understand that every
effort has been made to evaluate the dogs we place for good health
and non aggressive dispositions but that SCLRR, Inc. does not have
the manpower to assess each dog in all situations. Therefore, I
understand that SCLRR cannot guarantee the temperament or the
physical soundness of the dogs placed through the rescue. Most
Labradors have been examined by a veterinarian and most have been
evaluated in home-like settings. All should be handled carefully
until their dispositions are better known to their new owners, and
until their reactions to stressful situations (such as thunderstorms,
holiday fireworks, off-leash exercises) have been observed. In any
case, no dog should ever be left alone with a child.
I agree to abide by the terms of adoption, listed below:
- I am adopting the dog known as __________________ from the
Southern California Labrador Retriever Rescue organization. This
dog is male/female, _________ months/years/weeks old, and is
black/yellow/chocolate with the following (if any) distinguishing
marks: ________________________. The dog is spayed/neutered/intact
(see provisions for spay/neuter, if applicable, below).
- I will keep this dog in my personal possession, provide proper
and sufficient food, water, shelter, grooming and humane treatment
at all times.
- I will not allow this dog to breed or be bred under any circumstances.
- I will obtain veterinary care at once if he or she becomes sick
or injured and will keep current all vaccinations as recommended
by the veterinarian.
- I will provide him or her with an ID tag secured to a collar
which will be worn at all times.
- I will follow any and all animal control regulations governing
the area in which I live, and to license this dog according to local
regulations.
- I will assume full responsibility for this dog's actions, and
for any damage done by this dog from the time of adoption.
- I am aware of the additional details listed on the back of this
document and initialed by myself, of the facts that SCLRR has on
this dog.
- I will keep this dog as my household pet and companion. I will
insure that when outside and unattended, the dog is in a secure
fenced yard or kennel run with adequate shelter from the elements.
I will exercise it on leash and will never allow it to run loose
without adequate adult supervision. I will never chain or tie this
dog without being in attendance. I will not make this dog an outside
only dog.
- I will not relinquish ownership, abandon, or dispose
of this dog in any way. If I cannot keep it, I will contact the
SCLRR to return the dog. I do not expect reimbursement if this
happens.
- I will keep the SCLRR apprised of my current
address while I have this dog.
- I will allow an SCLRR representative
to examine the dog and its living conditions and to surrender it
to said representative for return to the organization if the
conditions are found unsatisfactory. This representative will perform
the check within a year of the date on this document.
- I am aware that it is SCLRR's policy to disclose any and all
known health problems for every fostered dog placed. Even so, I
realize that such problems can come to light after adoption. If
this proves to be the case, I hereby release SCLRR from any financial
or other responsibility for providing veterinary or other medical
care, unless a specific exception has been noted in this document.
If an exception is made, I will withhold treatment until SCLRR
approves the costs as disclosed in a written estimate from my
veterinarian.
RECEIPT
The adoptor has paid $ _____ (check# ______ or cash) for the dog
described in this document. Payment must be made in full at the
time of adoption. Volunteers may not authorize partial payments,
deferral of payment, or non-standard reductions without prior
approval of the Board of Directors. Reductions may be made for
dogs over 7 years, or in need of medical attention (not including
spaying/neutering in the case of an intact dog).
DISCLOSURE STATEMENT OF DEDUCTIBLE PERMITTED
Southern California Labrador Retriever Rescue, Inc, is an organization
that is recognized by the Federal Government as exempt from taxes
under the 501(c)(3) section of the Internal Revenue Code and to
which tax deductible contributions may be made. However, quid pro
quo transactions (transactions in which goods are received in
exchange for money) with nonprofit organizations may not be fully
tax deductible. The fair market value of the "item received in
trade" must be subtracted from the full amount to arrive at the
deductible amount. In surveying shelters located throughout Southern
California, the amount typically paid for a dog varies from $30 to
$70. Thus a reasonable market value for the dog is estimated to
be $50. Subtract $50 from the $ _____ paid to obtain $ ______,
which is the amount that may be considered a tax deductible donation.
Extra Conditions for #8 previously, if applicable
(Mark N/A otherwise):
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
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SPAY NEUTER DEPOSIT
The Labrador Retriever being adopted IS / IS NOT (circle) spayed
or neutered.
If the dog is intact, the adoptor agrees to file a deposit
with SCLRR (check#_____ or cash) and to spay or neuter the adopted
dog (check one)
____ Within 14
days of veterinary certification that the dog is healthy enough for
the surgery. The dog will be examined by the adoptor's Veterinarian
for this purpose no less than every 14 days until the certification
is obtained (current statement by a Veterinarian as to the health
of the dog is attached)
____ Within 30 business days
from the adoption date on this document
____ When the dog is considered old enough to be spayed
or neutered by the adoptor's Veterinarian (the suitable age shall
be no older than 6 months)
Proof that the dog has been neutered must be sent to SCLRR within
30 business days after the date of spaying or neutering for refund
of the deposit. If proof is not provided within this time, the
deposit is forfeited to SCLRR and the adoptor may be liable for
fines under Section 30523 of the California Penal Code. Upon timely
request, SCLRR will return the full amount of the deposit within
30 business days. The provisions for the spay/neuter deposit are
in full compliance with California's Assembly Bill 1856, chaptered
9/23/98 and effective 1/1/00.
MICROCHIP FEE OR DEPOSIT
The dog has the following MICROCHIP NUMBER:
________________________________
If the dog does NOT have a
microchip at the time of adoption, then the following applies: The
adopting family may bring the dog back to one of our events offering
microchips at a later date for free microchipping. Alternatively,
the adopting family may have a microchip done by their vet and apply
to SCLRR for a $25 refund. In the latter case, a copy of the
microchip number & certificate must be mailed to the PO Box below
for the refund.
I have read and agree to all of the above:
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Print Name: ________________________________________
Signature: _________________________________________
Date: _____________________________________________
Address: ___________________________________________
City, Zipcode: _______________________________________
Phone: (_____)_____________________________________
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SCLRR Volunteer: _________________________________________
Signature: _________________________________________
Print Name: ________________________________________
Date: _____________________________________________
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