Adoption Contract

Date *

MM

DD

YYYY

Your Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

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Date of Birth *

MM

DD

YYYY

Fee Covers: *

Adoption

Vaccination

Spay / Neuter

Micro-Chip

Refundable Deposit.

Spay/Neuter deposit.

$50.00 Spay Deposit

$50.00 Neuter Deposit

1. I will provide the animal with rabies vaccination in accordance with State and Federal law. Failure to comply is a criminal offense and will result in a citation. I will provide Proof of Vaccination by a veterinarian to the LARAS HOUSE OFFICE by 30 days from the time the animal reaches 4mo. of age.

I agree

2. State Law requires the animal to be sterilized in accordance to Chapter 828, Texas Health and Safety Code. I will have the animal spayed/neutered in accordance with this law. Failure to comply is a criminal offense and will result in a citation and/or the retrieval of the animal. *

Animal is already spayed/neutered

Animal will be spayed/neutered at LARAS House expense

I will have animal spayed/neutered at my expense AND provide proof of spay/neuter to LARAS House office by 30 days from the time the animal reaches 6 mo.

3. I understand that LARAS House cannot be held responsible for the health condition or behavioral problems that may occur with the animal. There is no guarantee as to health, physical condition, or behavior. *

I agree

4. I understand that LARAS House adoption fees are charitable contributions and that LARAS House will not, under any circumstances, make a refund of any adoption fee, including return of the animal. *

I agree

5. Boehringer Ingelheim respects your privacy . We will not sell or rent the information you provide on this form. By checking yes, you agree to receive special coupons, offers and information from Boehringer Ingelheim. Would you like to receive communication from Boehringer Ingelheim, the maker of Heart Gard, Next Gard, Heart Gard Plus and Frontline ? *

Yes

No

Your Signature *

First Name

Last Name