Date *

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DD

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Name *

First Name

Last Name

Home Phone

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Cell Phone *

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Work Place Phone

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Vet Name

First Name

Last Name

Vet Phone

(###)

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Landlord Name

First Name

Last Name

Landlord Phone

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Adoption Agreement *

To Apply to Adopt any dog from Nicholas Corey, Canine Connoisseur, you must first Agree to these Terms and Conditions (herein known as Adoption Agreement). I, Adopter, recognize that there are certain inherent risks associated when adopting animals, and I assume full responsibility for personal injury to myself, and further release and discharge Canine Connoisseur for injury, loss or damage arising out of this adoption. I agree, therefore, to indemnify Canine Connoisseur from and against all liability, claims, demands, damages, judgments and costs for or arising from loss or personal injury of myself or damage to my property suffered or sustained by me as a direct or indirect result of my participation as an adopter. Adopter agrees the dog will be cared for in a humane manner, including, but not limited to, providing fresh water, quality food, climate controlled shelter, exercise, and veterinary care. Adopter agrees the dog will be confined in the home when home alone, except for prolonged absences, such as vacation, where Adopter will pre-arrange care for the dog. The dog is not to be kept outdoors when no one is home. Adopter acknowledges that behavior observed by Canine Connoisseur is not a guarantee of behavior and that dog may act/behave differently in Adopter's home. Adopter agrees to properly and safely introduce adopted dog to members of their new family, including other animals in the house. Canine Connoisseur cannot guarantee adopted dog’s behavior in new environments, which includes the presence of any prey drive towards other animals that may occupy the same space as adopted dog. Canine Connoisseur does not condone off leash play except when in a fenced enclosure. Adopter agrees to keep the dog on a leash for exercise & potty breaks. Under no circumstances is the dog to be routinely tethered. Adopter will not use, nor will he/she allow the dog to be used for any illegal purpose. Adopter agrees that at no time will the dog be transported in the open bed of a pickup truck, or left in a vehicle unattended. Adopter agrees to take their dog to the vet, at Adopter's expense, at least once per year for a health check-up and appropriate shots. In the event the dog being adopted is less than 16 weeks old, Adopter agrees to take the dog into the vet (at their own expense) within 1 month for age appropriate vaccinations. Canine Connoisseur reserves the right to request a home visit to verify a successful placement and well-being of the dog. Adopter agrees to notify Canine Connoisseur in the event this dog is lost or stolen, and at the time of its death. Canine Connoisseur reserves the right to request and receive a veterinarian's "cause of death" statement in the event of the dog's death. If, for any reason, Adopter is unable to keep this dog for its entire life, Adopter MUST CONTACT Canine Connoisseur AND MAKE ARRANGEMENTS TO RETURN DOG TO Canine Connoisseur AT ADOPTER'S SOLE EXPENSE. Adopter acknowledges he/she is NOT permitted to rehome, sell, give away, or dispose of the dog in any manner (except humane euthanasia for medical reasons at the advice of a licensed veterinarian) without prior written consent of Canine Connoisseur. By checking the (I Agree) Box and entering your Name, you are agreeing to the Adoption Agreement.

I Agree

E-Signature *

First Name

Last Name