MISSISSIPPI BOSTON TERRIER RESCUE ADOPTION CONTRACT
Adopter's information:
Name: ___________________________
Address: __________________________
City: _____________________________
State: ____________________________
Zip Code: _________________________
Phone Number: ____________________
Information about Adopted Animal:
Dog's Name: __________________________ Breed: _____________________
Gender: ____________________________
Estimated Age: ______________________
Color: ______________________________
Adopter's Agreement:
1- I agree that the Boston Terrier is being adopted for myself and will not be sold, adopted, or
given to another party. ____________ (initial)
2- I agree the Boston Terrier will not be allowed outdoors without proper supervision. When
taking my dog outdoors, it will wear a secure collar or harness and wear proper ID.
_____________ (initial)
3- I agree that this Boston Terrier is being adopted as a companion animal. It will not be
trained to be aggressive or used as a guard dog. The dog will live inside my home, not
outdoors. _________ (initial)
4- I agree to care for the Boston Terrier in a humane manner and be a responsible pet owner.
This includes providing adequate water, food, shelter, attention, and medical care.
____________ (initial)
5- I agree and understand that this dog has been assessed regarding temperament to
MBTR's best ability and known mannerisms have been discussed with me prior to adoption. I
understand and agree that Mississippi Boston Terrier Rescue makes no guarantees about the
animals temperament and is not responsible for future damages or injuries caused by the
dog. ___________(initial)
6- I give Mississippi Boston Terrier Rescue permission to contact me on occasion, either via e-
mail or by phone at a reasonable hour, to ensure the well-being of the dog. I also understand
that I my contact Mississippi Boston Terrier Rescue if I have any questions regarding the dog
even after the adoption process has been completed. ___________(initial)
7- I agree that if at any point I can not keep the dog, no longer want the dog, or due to a
change in circumstances I can no longer properly care for the dog, I will return him/her to
Mississippi Boston Terrier Rescue without requesting a fee. ____________(initial)
8- Mississippi Boston Terrier Rescue shall not be responsible for any bodily injuries or
property damage caused by any adopted Boston Terrier or by the actions of its adoptive
owners. The adoptive owner hereby specifically assumes sole responsibility for, and agrees
to hold Mississippi Boston Terrier Rescue harmless from, any and all loss and expenses
(including legal fees) by reason of liability imposed by law upon Mississippi Boston Terrier
Rescue, or any of it's officers and members because of bodily injuries or death to any person
or persons including the adoptive owners, or any damage to property arising out of or in
consequence of the placement of the Boston Terrier, howsoever such injuries, death or
damage to property may be caused, whether or not the same may have been caused, or may
be alleged to have been accused, by negligence of the aforementioned parties or any of their
employees, agents or members, or any other person.__________(initial)
9- This dog is up-to-date on all vaccinations, spayed/neutered, and heart worm
negative/received Immiticide heart worm treatments and is on a monthly preventative. All
medical treatments have been discussed with me and dates provided when yearly
vaccinations are due. ___________ (initial)
10- The adopter agrees to pay MBTR an adoption fee of $__________. The fee is
refundable within seven (7) days provided that the adopter personally returns the living dog to
MBTR and releases MBTR from any liability associated with the dog while in the adopter's
care.
11- I agree that all statements made on this form are true and accurate. If it is found that any
statements on this form are not true and accurate, the adopted animal my be legally
confiscated and no adoption fees will be returned. ___________(initial)
12- I have been given copies of dog's vet records and vaccination records which should
accompany the dog to my vet for a 'new pet check' within 7 days of adoption. _______(initial)
13- I have read the preceding and agree to the conditions set forth this______ day
of__________, 2011.
***________ I am aware that this dog is being adopted with a fracture to the left jaw. It was
discovered by foster and vet after it was approximately 3 weeks old (Vet's estimation). Since it was
an older fracture and appeared to be in alignment, the decision was made by adopter and adoptee
to allow it to continue to heal on it's own. I was given Clavamox to continue to give the dog for
another week along with instructions of when and how much to give of the medication. I have also
been provided the orginal x-ray in the event I would like to consult my vet. Dog should remain on
soft diet for at least 4 more weeks.
Name: ____________________________________________________
Address: __________________________________________________
City: ______________________________________________________
State: _____________________________________________________
Zip Code: __________________________________________________
Phone Number: ____________________________________________
Adopter's Signature: ________________________________________
Witnessed (Rescue Member): _________________________________
Adopter's information:
Name: ___________________________
Address: __________________________
City: _____________________________
State: ____________________________
Zip Code: _________________________
Phone Number: ____________________
Information about Adopted Animal:
Dog's Name: __________________________ Breed: _____________________
Gender: ____________________________
Estimated Age: ______________________
Color: ______________________________
Adopter's Agreement:
1- I agree that the Boston Terrier is being adopted for myself and will not be sold, adopted, or
given to another party. ____________ (initial)
2- I agree the Boston Terrier will not be allowed outdoors without proper supervision. When
taking my dog outdoors, it will wear a secure collar or harness and wear proper ID.
_____________ (initial)
3- I agree that this Boston Terrier is being adopted as a companion animal. It will not be
trained to be aggressive or used as a guard dog. The dog will live inside my home, not
outdoors. _________ (initial)
4- I agree to care for the Boston Terrier in a humane manner and be a responsible pet owner.
This includes providing adequate water, food, shelter, attention, and medical care.
____________ (initial)
5- I agree and understand that this dog has been assessed regarding temperament to
MBTR's best ability and known mannerisms have been discussed with me prior to adoption. I
understand and agree that Mississippi Boston Terrier Rescue makes no guarantees about the
animals temperament and is not responsible for future damages or injuries caused by the
dog. ___________(initial)
6- I give Mississippi Boston Terrier Rescue permission to contact me on occasion, either via e-
mail or by phone at a reasonable hour, to ensure the well-being of the dog. I also understand
that I my contact Mississippi Boston Terrier Rescue if I have any questions regarding the dog
even after the adoption process has been completed. ___________(initial)
7- I agree that if at any point I can not keep the dog, no longer want the dog, or due to a
change in circumstances I can no longer properly care for the dog, I will return him/her to
Mississippi Boston Terrier Rescue without requesting a fee. ____________(initial)
8- Mississippi Boston Terrier Rescue shall not be responsible for any bodily injuries or
property damage caused by any adopted Boston Terrier or by the actions of its adoptive
owners. The adoptive owner hereby specifically assumes sole responsibility for, and agrees
to hold Mississippi Boston Terrier Rescue harmless from, any and all loss and expenses
(including legal fees) by reason of liability imposed by law upon Mississippi Boston Terrier
Rescue, or any of it's officers and members because of bodily injuries or death to any person
or persons including the adoptive owners, or any damage to property arising out of or in
consequence of the placement of the Boston Terrier, howsoever such injuries, death or
damage to property may be caused, whether or not the same may have been caused, or may
be alleged to have been accused, by negligence of the aforementioned parties or any of their
employees, agents or members, or any other person.__________(initial)
9- This dog is up-to-date on all vaccinations, spayed/neutered, and heart worm
negative/received Immiticide heart worm treatments and is on a monthly preventative. All
medical treatments have been discussed with me and dates provided when yearly
vaccinations are due. ___________ (initial)
10- The adopter agrees to pay MBTR an adoption fee of $__________. The fee is
refundable within seven (7) days provided that the adopter personally returns the living dog to
MBTR and releases MBTR from any liability associated with the dog while in the adopter's
care.
11- I agree that all statements made on this form are true and accurate. If it is found that any
statements on this form are not true and accurate, the adopted animal my be legally
confiscated and no adoption fees will be returned. ___________(initial)
12- I have been given copies of dog's vet records and vaccination records which should
accompany the dog to my vet for a 'new pet check' within 7 days of adoption. _______(initial)
13- I have read the preceding and agree to the conditions set forth this______ day
of__________, 2011.
***________ I am aware that this dog is being adopted with a fracture to the left jaw. It was
discovered by foster and vet after it was approximately 3 weeks old (Vet's estimation). Since it was
an older fracture and appeared to be in alignment, the decision was made by adopter and adoptee
to allow it to continue to heal on it's own. I was given Clavamox to continue to give the dog for
another week along with instructions of when and how much to give of the medication. I have also
been provided the orginal x-ray in the event I would like to consult my vet. Dog should remain on
soft diet for at least 4 more weeks.
Name: ____________________________________________________
Address: __________________________________________________
City: ______________________________________________________
State: _____________________________________________________
Zip Code: __________________________________________________
Phone Number: ____________________________________________
Adopter's Signature: ________________________________________
Witnessed (Rescue Member): _________________________________
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| Mississippi Boston Terrier Rescue P.O. Box 330 Bay Springs, MS 39422 Phone: (601) 764-6848 Fax: (601) 764-2166 e-mail: msbostonrescue@yahoo.com |
