BULLY PAWS a SOl(e) 3 non-profit organization PO BOX 285 Fredericksburg, Virginia (540)
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1 BULLY PAWS a SOl(e) 3 non-profit organization PO BOX 285 Fredericksburg, Virginia (540) bullypaws.adoptions@gmail.com ADOPTION, RELEASE AND INDEMNITY AGREEMENT Adopter's Name(s): Cynthia Stanley, Address: 3901 Doran Rd City: Fredericksburg State:...:.V.... A~ County of residence:...!s""p~o~t::::.sv~l~v.:::a~m~ a:...- -Y Social Zip: _ Security #/Driver's L).cense #/Respective State: / r ill!' 0 =17-"Q3 / VA Date of Birth: 3/9/1953 Social Security #/Driver's License #/Respective State: / / Date of Birth: _ Address:cvnstanley@comcast.net Phone: (540) Work #: (540) Cell#: _ Emergency contact: _ AGREEMENT made this 13 day of August, 20 13, between Bully Paws - Pit Bull Patriots, Inc. (referred to in this agreement as Bully Paws), represented by Bully Paw's agent Barbara M Donegan (referred to in this agreement as "rescuer"), an individual residing at New Bond Street. Fredericksburg, VA 22408,telephone number and CYnthia Stanley (referred to in this agreement as "adopter"), an individual residing at 3901 Doran Rd Fredericksburg,VA telephone number..l..(5""'4...,olj)"""84::r.;0""'-..::::!4""6.>l66"'--, address cvnstanlev@coidcast net WHEREAS, Rescuer has protective custody, on behalf of Bully Paws, of the following described animal (referred to in this agreement as "Dog"): Breed: American Pit Bull Terrier (short coat) : Sex Mak,; Estimated Age: 4 Years 3 Mop, Color: Fawn, Microchip #: 4c2 d4c 3b36 ; Name: ropeye ; and WHEREAS, Adopter wishes to take custody of Dog; AND WHEREAS, Adopter certifies that Adopter and no one in Adopter's residence has been convicted of animal cruelty, neglect or abandonment: NOW, THEREFORE, for and in consideration of Rescuer's relinquishment of custody of Dog, Adopter hereby gives and grants unto Rescuer and Bully Paws, as a basis on which Dog is released, this Adoption, Release and Indemnity Agreement, and promises, covenants and agrees as follows: Bully Paws - Pit Bull Patriots, Inc.
2 r HOLD HARMLESS Rescuer and Bully Paws (and its members and volunteers) shall not be liable to adopter on any theory oflegal liability including the sole or concurrent negligence of Rescuer and/or Bully Paws (and its members and volunteers), for any injury, death or damage directly or indirectly caused by Dog. Adopter does hereby release Rescuer and Bully Paws (and its members and volunteers) from any and all liability, claims, suits, demands, or causes of action which may presently be in effect or may arise out of or be brought against Rescuer and Bully Paws (and its members and volunteers), by virtue of the release of Dog to Adopter. It is the expressed intention of Adopter, Rescuer and Bully Paws that the release provided for in this paragraph is designed and intended to protect Rescuer and Bully Paws (and its members and volunteers) from the consequences of any attack, behavior or other action by Dog, and from the consequences of any act or omission or negligence on the part of Rescuer and Bully Paws (and its members and volunteers) in obtaining custody of Dog, in providing care for Dog, or in failing to provide timely or adequate warning to any person concerning Dog. Please initial here to signify that the parties have read and understood this section: Adopter's Initials: 0?/ ~ INDEMNIFICATION Adopter expressly agrees to defend, pay, indemnify and hold harmless Rescuer and Bully Paws (and its members and volunteers) from all suits, actions, losses, damages, claims, or liability of any character, type or description, including without limiting the generality of the foregoing all expenses oflitigation, court costs, and attorney's fees for injury or death to any person, or injury to any property, received or sustained by any person or persons or property, arising out of or occasioned by, directly, or indirectly, the release of Dog to Adopter. It is the expressed intention of Adopter, Rescuer and Bully Paws (and its members and volunteers) that the indemnity provided in this paragraph is designed and intended to protect Rescuer and Bully Paws (and its members and volunteers) from the consequences of any attack, behavior or other action by Dog, and from the consequences of any act or omission or negligence on the part of Rescuer or Bully Paws in obtaining custody of Dog, in providing care for Dog, or in failing to provide timely or adequate warning to any person concerning Dog. Further, Adopter expressly agrees to hold harmless Rescuer and Bully Paws (and its members and volunteers) from all suits, actions, losses, damages, claims or liability of character, type or description, including without limiting the generality of the foregoing all expenses, of litigation, court costs and attorney fees associated with Bully Paws reclaiming Dog in the event Adopter violates any provisions of this contract. Adopter further agrees to reimburse Bully Paws for any and all expenses associated with reclaiming Dog in the event Adopter violates any provisions of this contract. Please initial here to signify that the parties have read and ~Od Adopter's Initials: ~ this section; No WARRANTIES O~REPRESENTATION dopter understands that Rescuer and Bully Paws make no warranties (express or implied) or representations as to: ~hehealth, fitness, demeanor or well being of Dog. Adopter accepts Dog "as is". Because of this, AdopteL understands that Rescuer and Bully Paws (and its members and volunteers) accept no responsibility if dog shoul ~ie after being released to Adopter or should bite, scratch, injure, or cause the death of any person or animal o~. cause damage to property after being released into Adopter's custody. Adopter understands that dogs adopted from! ~ shelter may have contagious diseases transmittable to their other pets and will make reasonable attempts t~ keed animals se arated for 7-10 days to prevent transmission of kennel cough! upper respiratory infections and/op parasites.~~...,_.,."...,..._..,..._..."_,... ~_,...,.. ~..,...,.._...,,..., Please initial here to sig.!lifythat the parties have read and understood this section: ~ooter's Initials: ~y 2 ' Bully Paws - Pit Bull Patriots, Inc.
3 Adopter further promises, covenants and agrees to the following: 1. I/We will care for Dog lovingly (including but not limited to adequate food -- fed at least one time per day), shelter fresh water at all times, sufficient exercise ~ time, veterinary care and love); _ Adopter's Initials: ow ~ ~ 2. I/We will use the following veterinarian: Dr. Ireland I ~ ~/ at phone number: ~ (:)-54 f ~5f and ensure Dog is maintained on heartworm preventative year round (including testin for heartworm as needed), provide dental care as recommended by vetennanan, and keep all testing and immunizations current and updated according to a veterinarian's schedule; and if Dog develops a condition where daily prescription ~tion is indicated J/we will provide such medication; ~ / Adopter's Initials: ~ 3. I/We will license Dog in accordance with the laws and ordinances, and abide by the leash laws and ordinances of the municipality, county and state in. we live; Adopter's Initials: ~ 4. I/We will ensure that Dog wears a collar and approprr~.i~ntifications tags when not in the house; Adopter's Initials: ~ ~J 5. I/We will keep Dog as a house pet, never left alon~ to be exercised in a fenced yard N on a leash, and not to be all~wed to!yam the streets; Adopter's Initials: ~. 6. I/We will ensure that Dog is enrolled in a group obedience training class within one calendar month of adoption andthat upon completion of the Obedience Class, I/we will provide Bully Paws the completed Obedience Requirement Form for record; ~ Adopter's Initials: ~ ~ 7. I/We will not allow Dog to ride in the open bed of a pickup truck and will never leave Dog unattended in a vehicle or truck bed cap for ANY period of time, NO MATTER how short a period and NO MATTER what time of year;!a..ajl. Adopter's Initials: ~/ ~ 8. I/We agree that the adoption of this Dog is as a personal family pet, not as a gift or for the purpose of providing Dog to anyone else. I/We agree not to sell, trade, abandon or dispose of Dog in any way before informing Bully Paws, which shall have the option of retaking custody of Dog. Further, I/we agree to be liable for costs associated with violation of this section; said expenses not intended to replace or alter any rights Bully Paws has pursuant to Section 13 belowlr '" Adopter's Initials: ~ ~ 9. I/We understand that Dog shall not be used for any medical or experimental purposes; shall not be kept chained or tied or put on a "zip line" or trolley; shall not be used for breeding; shall not be trained or used as an attack dog; shall not be used for dog fighting, baiting or hunting; and shall not have its ears cropped, tail docked 0' any other cosmetic surgery pwced~ when recommended by a veterinarian fn medical reasons; Adopter's Initials: t1;:);>j 3 Bully Paws - Pit Bull Patriots, Inc.
4 10. IlWe understand that Bully Paws reserves the right to examine and make inquiry about Dog at any time. If I1we fail to keep Dog in accordance with the terms of this Agreement, ifi/we deny Bully Paw's right to examine, if I/we fail to respond to any Bully Paws inquiry or if I1we have made any misrepresentation of fact, Bully Paws may retake custody of Dog; additionally any costs associated with such retaking of custody shall be my/our sole responsibility. If any medical care is required as a result of any intentional or negligent act of mine/oms, any and all costs associ~ said medical care shall be my/our sole responsibility; "A. ) Adopter's Initials: lyyy 11. IlWe agree to advise Bully Paws of any change of a~phone number(s), and/or address; Adopter's Initials: Q..W ~ 12. IlWe agree to advise Bully Paws of any actions pending and/or taken by local animal control officials regarding Dog, me/us or any individual in my/our.~e1\ld. Adopter's Initials: ~/ Rescuer's Initials~ 13. IIW e agree to advise Bully Paws of any charges and/or convictions of me/us or any individual in my/our household for animal cruelty, neglect or abandonme~a' a-.. Adopter's Initials: ~ ~ 14. IlWe agree that if Dog is not spayed or neutered before its adoption by me/us, that I/we will have Dog spayed or neutered as soon as possible, by the time it is six months old if applicable, or as soon as it is deemed safe to do so by a veterinarian and I1we will provide documentation to Bully Paws within thirty (30) days of procedure; Adopter's Initials: ~ a.ṅ,.., 15. IlWe understand that tge Adoption fee is not refun Adopter's Initials: ~ g7flyl==" 19. IlWe certify that we do not live in an area where "Pit Bulls", American Staffordshire Terriers, Staffordshire Terriers, Bull Terrier or any mixed bull b,e~ed. Adopter's Initials: {i4i2..i 20. IlWe agree to relinquish custody if at which time the laws in my community, county, or state forbid me to keep the Dog due to Breed Restrictive Legislation (BSL) or if affected by BSL due to a change in residence, and will contact Bully Paws 120 ~RE the law goes into effect, it may be requited to surrender Dog to~ custody. Adopter's Initials: 21. IlWe have contacted our homeowner's insurance company and determined there are no breed restrictions which would prevent attaining or maintaining my coverage. In the event of breed restriction being placed on my policy, I will try to the best of my ability to obtain a new policy which will cover the Dog and ifi cannot do so, will relinquish custody of the Dog to Bully Paws. 4 Bully Paws - Pit Bull Patriots, Inc.
5 1- Adopters' Initials: flj:i ~ 22. IIW e understand that Bully Paws is a duly registered Virginia corporation and this adoption agreement shall be construed in accordance with the laws of the State of Virginia. I1We and Bully Paws agree that any and all litigation or disputes resulting from this adoption agreement pursued by either party to this agreement shall be pursued in the pistriet Court for S~ania County, Virginia. Adopter's Initials: tt)1/ 23. IIW e agree to notify Bully Paws if at any point Dog becomes missing, sick, injured or can no longer be cared for by adopter(s) listed above. Adopter's Initials: W ~ SIGNED, this 13 day of August,20 13 I hereby verify that I am eighteen (18) years of age or older, that I fully understand my rights and obligations as described above and that failure to comply with these obligations will be considered a breach of contract. Said breach of contract gives Bully Paws the rights contained in this contract and any and all rights afforded by law to terminate any ownership of Dog and thereby the legal right to reclaim the animal without refund and recover any and all expenses associated with the enforcement of this contract. Rescuer 5 Bully Paws - Pit Bull Patriots, Inc.
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