Border Collie Rescue, Australia
Adoption Agreement

($_______ ) dollars, the receipt of which is acknowledged, ownership is transferred to the undersigned adopter(s) who releases, discharges and holds harmless Border Collie Rescue, Australia, (BCRA) and anyone else associated with BCRA, from any charges or claims arising from the adoption of:

Name of Dog __________________________________

Description ___________________________________

on (Date) ______________________________________

TERMS OF ADOPTION

THE UNDERSIGNED agrees to abide by the following terms of Adoption.

1. Return/Settling in period: The above-designated dog may be returned to BCRA within three weeks of the above date for a full refund of above-specified payment if the adopter is not satisfied with any aspect of the adoption. After three weeks from the above date, no refund will be given even if the dog is returned to BCRA.

2. Transfer of Ownership: The above-designated dog may not be transferred to any other person for any reason. If the undersigned adopter is forced to relinquish custody of the dog at any time, said dog will be relinquished only to BCRA.

3. Refund: There will be no refund or reimbursement for any expenses incurred by the adopter for the above-designated dog, even if it is returned to BCRA.

4. Health Program: The above-designated dog will be cared for humanely, including adequate food, shelter, water and veterinary care and will be licensed in accordance with the laws of the jurisdiction in which he resides.

5 Safety: During the three week settling in period, the above-designated dog will, at all times, wear a collar with identification tag attached.  Also during this period this dog will not be allowed off my property, or allowed in any unsecured area, without a collar and leash.  The dog is to be exercised in a fenced yard or on a leash and NOT TO BE FREE TO ROAM THE STREETS.

6. Reason for Adoption: The above-designated dog is to be kept as a house pet; it shall not be used for medical or any other experimental purpose; it shall not be chained or tied, and it shall not be used for breeding.

7. Loss: If the above-designated dog is lost or stolen, the adopter will notify BCRA within three (3) days.

8. Reservation of Rights: BCRA reserves the right to enforce this contract in order to protect the welfare of the above-designated dog. It is understood that BCRA may examine and may make inquiry about said dog at any time. If the terms and conditions of the Agreement are not upheld, BCRA reserves the right to terminate this Agreement and to reclaim the dog.

9. Return check charge: There will be a $25.00 charge on all returned checks submitted by the adopter.

ADOPTION RELEASE

NEW OWNER(S) NAME:______________________________________

ADDRESS:______________________________________

______________________________________________

PHONE:_______________________

WORK:________________________

ADDITIONAL INFORMATION:__________________________________

_________________________________________________________

_________________________________________________________

IDENTIFICATION (Driver's License or I.D. Card)

_____________________________

INFORMATION ABOUT DOG:

 CURRENT NAME ____________________________________________

AGE __________ COLOR __________________________ SEX _______

RESCUE NUMBER  ____________________

MEDICAL:

SPAYED OR NEUTERED ________________ DATE ________________

RABIES VACCINATION DATE ____________ EXPIRES _____________

OTHER SHOTS AND DATES

________________________________________________________

_________________________________________________________

_________________________________________________________

_________________________________________________________

ALLERGIES ______________________________________

MEDICINE ______________________________

DEWORMING ___________________________ DATE _____________

DOG LIKES:

WATER ____ CHILDREN ______ CATS ______ OTHER DOGS ______

STRANGERS ______ PLAY ____ RIDES IN A CAR ______

SPECIAL TOYS ________________________ BLANKET ______

OTHER ___________________________________________________

_________________________________________________________

_________________________________________________________

HABITS:

HOUSEBROKEN _______

SIGNAL TO GO OUT ______________________________

JUMPS FENCES ____ DIGGING ______

CHEWS FURNITURE OR OTHER ITEMS __________

TRICKS __________________________________________________

_________________________________________________________

_________________________________________________________

LEASH TRAINED ______ COLLAR ____ HALTER ______

TRAINING RECEIVED:

_______________________________________________________

________________________________________________________

DEGREES:

_______________________________________________________

________________________________________________________

OTHER:_________________________________________________

FEEDING INSTRUCTIONS:___________________________________

________________________________________________________

_________________________________________________________

SUPPLEMENTS _____________________________________________

 ADDITIONAL INFORMATION:

_________________________________________________________

_________________________________________________________

_________________________________________________________

I hereby acknowledge receipt from BCRA of the dog described above. I accept the dog as is and assume all risk and financial responsibilities of ownership. I hereby release BCRA from any liability associated with any illness of the dog or damage, accident or injury hereafter caused by said dog. I agree that BCRA will not in any way be held responsible for the conduct of this dog after its adoption. I understand that some or all of the information provided on the Adoption Agreement regarding said dog may have been received by BCRA from a third party; I understand that BCRA does not warrant the accuracy of such information. In addition if the dog was found wandering or lost, I acknowledge that BCRA has no knowledge of the prior owner(s) of the dog, and that the prior owner(s) may contact me at any time with regard to retaking the dog. If this occurs, the only remedy I will have is that BCRA will provide me with another dog, if and when one is available and I so desire, at no additional cost to me. If at any time I desire to relinquish custody, or BCRA demands its release for failure to comply with agreement, I agree to return said dog to BCRA making no charges of any nature for licensing, care, food or other services or items. I agree to pay any reasonable attorney fees and court expenses if BCRA must bring legal action against me to enforce this Adoption Agreement. I understand that any sum of money I have given to BCRA is to be used for its work in caring for this and other Border Collies and is not refundable except as provided in "Terms of Adoption" number 1.

I hereby acknowledge that I have read and understand the Adoption Agreement and agree to abide by all of its rules and regulations set forth herein. I pledge that I will keep the dog described herein as a part of my family.

Signed this ___________ day of ______________, 19_______.

Agent for BCRA   ___________________________________

Signature of Adopter ___________________________________

Signature of Co-Adopter (if any) _____________________________

Print this application, sign the completed form, and post to:

Border Collie Rescue, Australia
49 Fords Rd
Thirroul NSW 2515

Phone: (02) 9401-9928