WHITE BOXER RESCUE
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Connie & Dan Domeracki           PO Box 734        North Cape May, NJ 08204
(609) 889-7629
[email protected]
FAX: (240) 465-8134
 
  l. I HEREBY ADOPT_______________DESCRIBED BELOW. FROM AND AGREE TO THE RULES OF
CONNIE & DAN DOMERACKI & WHITE BOXER RESCUE.
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  2. THE DOG WILL BE MAINTAINED AS A HOUSE PET. THE DOG WILL BE LIVING INDOORS WITH ME AS A COMPANION. REGULAR MEDICAL CARE WILL BE PROVED BY A VETERINARIAN AS NECESSARY TO KEEP THE DOG IN GOOD HEALTH. ANNUAL INOCULATIONS AND HEART WORM TESTING WILL BE PROVIDED, AND RABIES INOCULATIONS GIVEN AT THE PRESCRIBED FREQUENCY AT MY EXPENSE. THE DOG WILL BE LICENSED BY LOCAL AND/OR STATE AUTHORITIES AS REQUIRED BY LAW. I UNDERSTAND THAT IN SOME STATES THERE ARE SUBSTANTIAL FINES FOR NOT HAVING A DOG LICENSED, OR RABIES INOCULATIONS NOT BEING UP TO DATE. ALSO THE DOG WILL NOT BE COSMETICALLY TRANSFORMED IN ANY WAY. THE DOG WILL WEAR A TAG WITH THE DOG'S NAME, OWNER'S NAME, ADDRESS, AND PHONE NUMBER AT ALL TIMES. THE DOG WILL NOT BE TIED OUT AT ANY TIME.

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  3.  IF AT ANY TIME, I BECOME UNABLE TO CARE FOR THE DOG PROPERLY, I  WILL CONTACT THE ADOPTING REPRESENTATIVE. THE DOG MAY ONLY BE GIVEN TO A NEW OWNER UPON PRIOR APPROVAL OF SAID REPRESENTATIVE.
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  4.  IF THE DOG MUST BE RETURNED TO RESCUE, I AGREE TO HOLD OR BOARD  SAID DOG UNTIL SPACE IS AVAILABLE. THIS PERIOD WILL NOT EXCEED 15 DAYS.
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  5.  IF THE DOG IS NOT SPAYED/NEUTERED I WILL HAVE THIS PROCEDURE DONE ON OR
 BEFORE ___________ AND PROVIDE RESCUE WITH PROOF OF SUCH.
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  6.  ONE OR MORE HOME VISITS MAY BE MADE WITH OR WITHOUT PRIOR NOTICE, AND I HEREBY AGREE TO THIS. THE ADOPTING REPRESENTATIVE MAY EXAMINE OR MAKE INQUIRIES ABOUT THE DOG AT ANYTIME. IF SAID REPRESENTATIVE IS NOT SATISFIED WITH THE MANNER IN WHICH THE DOG IS BEING KEPT THE DOG MAY BE IMMEDIATELY RECLAIMED. RECLAIMING OF THE DOG WILL NOT BE CONSIDERED A TRESPASS OR THEFT.
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7. IF AT ANY TIME THERE ARE PROBLEMS WITH THE DOG, I WILL ADVISE  THE ADOPTING REPRESENTATIVE, AND SEEK THEIR RECOMMENDATIONS  FOR A RESOLUTION.

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   8. NEITHER WHITE BOXER RESCUE NOR CONNIE & DAN DOMERACKI SHALL BE  HELD RESPONSIBLE FOR ANY DAMAGES, COSTS, OR EXPENSES, INCURRED BY  THE ADOPTER, RESULTING FROM THIS PLACEMENT, INCLUDING, BUT NOT  LIMITED TO, DAMAGE OR INJURY TO PERSONS OR PROPERTY. IN THIS CONNECTION THE ADOPTER RELEASES THIS RESCUE, AND CONNIE &  DAN DOMERACKI HARMLESS FROM ANY AND ALL LIABILITY OF ANY AND  EVERY NATURE AND CAUSE, DIRECTLY AND INDIRECTLY RELATING TO THE  PLACEMENT OF ANY DOG.
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I AGREE TO KEEP RESCUE INFORMED OF DOGS PROGRESS AND SUBMIT, AT LEAST
ONE CLEAR PHOTO AND UPDATED SHOT RECORDS PER YEAR, FOR RESCUES FILES.

I UNDERSTAND THAT VIOLATION OF ANY TERMS OF THIS CONTRACT, IN
THE OPINION OF THE RESCUE, CONSTITUTES RETURN OF THE LIVE ANIMAL AND ANY
COURT COSTS WILL BE ABSORBED BY THE ADOPTER.

SIGN AND DATE PLEASE

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              [email protected]

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ANIMAL INFORMATION
(FOR RESCUE USE ONLY)

BREED___________________

NAME____________________

DHLPPC DATE____________

RABIES DATE & TAG# _______________________

APPROXIMATE AGE ________________________

FECALS AND/OR WORMING _______________________________

FLEA CONTROL __________________________________________

HEART WORM PREVENTIVE DATE ________________________

COLOR ___________________

SPAY/NEUTER DATE _____________________

SIZE __________________

COAT_________________

FEEDING FREQUENCY ____________________________________________________

BRAND OF FOOD _________________________________________________________

MEDICATIONS (if any) _____________________________________________________

SPECIAL NOTES & PERSONALITY COMMENTS _______________________________________________
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