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Jan. 2022

Hollywood Dog Rescue Adoption Agreement

501C EIN 46-2782047/ NYS Reg RR068

11 Stella Ln. Pine Bush, NY 12566


I, the adopter, ______________________________________________________understand that by adopting a pet I must comply with all of the following requirements and that failure to do so may result in the animal being reclaimed by Hollywood Dog Rescue.

Date ______ Dogs Name____________ Breed________, Color,_____ Sex_______, Fixed _____ .

DOB/ Approximate age ______ .

Adopters Name: ___________________Address: _____________________Phone:________________

Email: _____________________________________

I, ________________________hereafter referred to as the adopter, herby understands and agrees that the above described animal is being adopted solely as a pet for myself or immediate family.

___I agree that I will not sell, give away or otherwise dispose to any person (s), dealer, retailer, Auction, institute, or any other entity for any reason. If at a later date,

___I am unable to keep this pet, I agree to first contact Hollywood Dog Rescue and give them the option to reclaim said pet at no charge.

___I understand and agree to care for the above-described pet in a humane and responsible

manner, to provide it with clean and adequate shelter, food, water and Veterinary care.

___I further agree that said pet shall reside inside my home and shall not be allowed to roam freely and that

at no time is my pet to be chained or tied up as a means of restraint

___I understand and agree that Hollywood Dog Rescue may investigate my adopted pet’s new home at any time and if the home is deemed unsuitable by Hollywood Dog Rescue or if the facts given

regarding this adoption has been misrepresented then Hollywood Dog Rescue may confiscate

the animal and no refund will be given. I understand and agree that if I move, change my phone number or Email address I will contact Hollywood Dog Rescue and provide the new updated information.

___I understand that I will call a veterinarian within 72 hrs. of picking up my pet and making an appointment for a wellness visit.

___I understand and agree to have my pet vaccinated against Rabies, comply with local laws and have the pet Spayed or Neutered, if not already done. I agree to purchase a city/ county/ town animal license in accordance with local governing requirements.

___I agree to attach the issued tags to a properly fitted dog collar which will be worn by the pet at all times.

___I understand and agree that Heart Worms are ultimately Fatal to the dog and will provide my pet with monthly Heartworm preventative Medication during its entire Lifetime.

I hereby understand and agree that the adoption fee helps to cover Hollywood Dog Rescue’s expenses and agree to give the dog at least a full two weeks to adapt to its new surroundings before I notify Hollywood Dog Rescue that I have become unable to continue care for my adopted pet or seek to transfer ownership of my pet, regardless of the reason, at any time after the adoption is completed. The adoption fee is nonrefundable after two weeks.

___ I understand that my pet has been given rescue wellness treatment from the originating animal shelters prior to adoption. I hereby and fully understand that Hollywood Dog Rescue cannot guarantee the future health of my adopted animal.

___I fully understand that if my pet develops any kind of illness or condition that the adopter is fully responsible for its care, treatment, associated expenses and that no refund in part or in whole will be given.

___I have read the above adoption requirements for adopting an animal from Hollywood Dog Rescue and do

agree to abide by the adoption requirement.

___I certify that all statements made by me (the adopter) on this agreement are true and correct.

___I agree that Hollywood Dog Rescue, the current owner, has the unconditional right to confiscate the above described animal in the event that any statements

made by me (the adopter) are found to be false and / or if my ( the adopter) check for the adoption fee is returned to Hollywood Dog Rescue for insufficient funds or any other reason.

Adopters Name Signature

Date .