Animal's Name___________________________ ID#____________________

Adopter_________________________________________________________

Address________________________________________________________

I hereby acknowledge receiving the above described animal.
I agree to provide proper food, water, adequate shelter, and kind treatment at all times.
I hereby agree to take the animal to a veterinarian for examinations and immunizations as needed; and to procure immediate veterinary care, at my own expense, should the animal become ill or injured.
I agree to have this animal spayed/neutered by:______________(date). I understand that this animal may not under any circumstances, be allowed to breed.
I agree not to have this animal declawed or to have this animal mutilated in any other way, including having the tail docked or the ears clipped.
I agree to license the animal in compliance with the laws and ordinances of the municipality in which I reside.
I agree not to chain or in any other way tether this animal without the express written permission of CCHS.
I agree to return this animal to CCHS if I cannot, for any reason, keep this animal. I also agree to give CCHS a period of up to 7 days to take back this animal so that appropriate accommodations for this anim al can be made.
I agree not to allow this animal to be used for medical or other experimental purposes.
I agree to allow CCHS representatives reasonable entry onto my property to view this animal and its living conditions and to insure that it is being cared for in compliance with this agreement.
I have read all of the above. I have had it explained to me and I completely understand and accept the rights and obligations above.
I understand that CCHS cannot guarantee the health, temperament, or training of the above described animal and hereby agree to release CCHS from all liability once the animal is in my possession.