First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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Email*

Home Phone

Work Phone
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Cell Phone*

Spouses Name:

Spouse's Phone Number

Spouse's Email Address:

1.) THE DOG: We are placing the following described dog with you, the Adopter(s), for the adoption as a companion dog and family member:*
Choose an animal: Delta Fiona Hank Honey Meredith Mr. Bojangles Oro Tatiana Tiana Tiger

2.) ADOPTION DONATION: To assist us in continuing our rescue work, Adopter(s) agrees to make a donation of $______. This donation is immediately used to pay the ongoing costs of rescuing stray, owner surrender, and shelter animals; to include food, veterinary care, kenneling costs, transport, etc. Your donation is tax deductible and NONREFUNDABLE.*

3.) CARE OF DOG: You agree that this Dog is being adopted as a family member and will be given extensive house privileges; i.e. sleep inside the house, be allowed freedom of the house when the family is home, and will NOT be restricted to the yard for long periods of time. You agree to provide the Dog with fresh water, wholesome dog food, adequate outdoor exercise, affection, and shelter.*
Choose one: I agree I disagree

4.) VETERINARY CARE: You agree to keep all vaccinations current, including but not limited to, Rabies, Distemper/Lepto/Parvo (DHLPP), Bordetella; maintain flea control AND endure the Dog received preventative medication to protect against heartworm. You agree to provide the best available care to the Dog in a timely manner. Any veterinary problems and costs that may arise, including serious illness requiring emergency care or surgery, is your responsibility.*
Choose one: I agree I disagree

5.) BEHAVIORAL ISSUES (i.e. biting, destruction, escapism, fearfulness, dominance that might lead to abandonment of the animal): Adopter(s) agree to contact FILA 911 RESCUE AND REHAB to follow the recommendation in resolving any issues as an effort to maintain custody of the adopted animal. If a resolution cannot be acheived, the adopter(s) agree to return the adopted animal to FILA 911 RESCUE AND REHAB.*
Choose one: I agree I disagree

6.) Spay/Neuter: Spay/neuter: I agree to have the above described pet altered no later than _______(Date) by a licensed veterinarian. If I choose to not return the dog to be spayed or neutered by the rescue’s veterinarian, I will provide Fila 911 Rescue and Rehab with written evidence of this surgery within ten (10) days after it is performed and the expenses incurred for the procedure will be my responsibility. Fila 911 Rescue and Rehab WILL NOT REIMBURSE YOU FOR THESE EXPENSES IF YOU CHOOSE TO HAVE YOUR VETERINARIAN DO THE REQUIRED SPAY OR NEUTER PROCEDURE!*

I understand that this Agreement and Waiver of Liability protects and is for the benefit of the Rescue, its affiliates, and the officers, directors, consultants, volunteers and all others acting on behalf of the Rescue and its affiliates.*
Choose one: Yes No

I agree that I will not sue, prosecute, or make any other claim against the Rescue for injury or damage to me or my property arising out of the adoption or any related activities performed on behalf of the Rescue and resulting from negligence or other acts, however caused, by any Rescue officer, volunteer, employee, agent, workman, contractor or other authorized representative.*
Choose one: Yes No

I understand that the terms of this Agreement and these rights apply to and bind me, my heirs, successors, assigns, guardians or other legal representatives.*
Choose one: Yes No

By typing Adopter(s) full legal name, you accept this as a digital form of signature:*