Adopter Information Name (Required)
Email (Required) Animal Information Sex Vaccination Information Other Dog Information Other Notes or fun facts: Spay/Neuter Information Spay/Neuter Complete? (Required) Spay Neuter Agreement
Provisions shall be made for the sterilization of all dogs and cats sold or released for adoption [or purchased] from any public or private animal shelter or animal control agency operated by a humane society, or by a county or city, or other political subdivision pursuant to sections 273.400 to 273.405 of the Missouri Animal Care Facilities Act. Pursuant to these regulations, adopter will be entering into a written agreement with Lucky Chance Rescue that sterilization will be performed by a Lucky Chance Rescue participating licensed veterinarian, in compliance with this sterilization agreement
If you are adopting a dog who has not yet been spayed or neutered; you will be required to complete and agree to the terms of our Spay/Neuter Agreement. Your home family dog(s) must be altered prior to adoption. The only exceptions are dogs who cannot undergo surgery for medical reasons. Written proof from your veterinarian stating medical reasons will be required prior to adoption. Please read the agreement carefully, you will be required to agree to these terms if you are adopting an un-altered animal.
Agreement to Spay/Neuter The Adopter acknowledges that as of the date of this Agreement, the dog is not spayed or neutered, and the Adopter agrees to have the dog spayed or neutered no later than 30 days from the date of adoption agreement, or when medically ready as determined by Lucky Chance Rescue Veterinary recommendations Ownership of Dog I Agree Permanent ownership of this dog is contingent upon compliance with this Spay/Neuter Agreement between Lucky Chance Rescue and the ‘Adopter’. In consideration of an adoption donation as described in the adoption agreement, Lucky Chance Rescue has transferred all rights, privileges, and responsibilities associated with the dog described in the Adoption Agreement. Date of Spay/Neuter I Agree The Adopter acknowledges that as of the date of this Agreement, the dog is not spayed or neutered, and the Adopter agrees to have the dog spayed or neutered no later than 30 days from the date of adoption agreement or between the dates stated above, or when medically ready as determined by Lucky Chance Rescue Veterinary recommendations. A letter from our veterinarian will be required to postpone due to health reasons Adopting Intact (Unneutered/Unspayed) Dogs with Spay/Neuter Clause Proof of Spay/Neuter I Agree Proof of spaying or neutering of the dog must presented to Lucky Chance Rescue not more than fourteen (14) days after the date of the spay/neuter surgery. Proof of spay/neuter (spayed/neutered certificate) must be sent in the form of a scan or photo to email@example.com or mailed to: Lucky Chance Rescue, 2303 Flowering Ash Lane, Lake St. Louis, Mo 63367 If the Adopter fails to provide proof of spaying / neutering within the time set forth above, this Agreement will be enforced, and the appropriate legal authority will be notified. In addition, all rights, privileges and responsibilities of the dog shall automatically terminate and transfer back to Lucky Chance Rescue, and Lucky Chance Rescue will immediately assume possession of the dog. The Adopter shall pay all reasonable attorney’s fees incurred in attempts to repossess the dog. If proof of spay/neuter is provided after the time limits set forth above, ownership of the dog shall be determined on a case-by-case basis. Lucky Chance Rescue may allow extensions of the time periods upon receipt of a certificate from a Lucky Chance Rescue licensed veterinarian that certifies that the dog has a medical condition which prevents him or her from being spayed/neutered, or that it would otherwise be detrimental to the health of the dog to be spayed/neutered. In such a case, the dog shall be spayed or neutered when the dog is healthy enough, as certified by a Lucky Chance Rescue licensed veterinarian The dog shall be spayed or neutered within thirty (30) business days of that certification, or the conditions set forth above will be enacted. Vet Clinic To Perform Surgery Please Choose Anheuser Animal Clinic - Bloomsdale Animal House Veterinary Hospital - Arnold Clayton Road Veterinary Hospital - Chesterfield Four Paws Animal Hospital - O'Fallon, IL Franklin County Animal Medical Center Hawk Ridge Animal Hospital Spencer Creek Veterinary - St. Peters Terms & Conditions Spayed/Neuter Agreement
Spayed/Neutered certificate must be presented to the Lucky Chance Rescue participating licensed veterinarian at time of appointment.
This certificate covers the cost of a routine spay/neuter procedure including a cursory (not full) surgical pre-exam, anesthesia, surgical procedure, waste disposal, day of surgery post-operative care and pain-relief, hospitalization as required, and stitch removal if necessary.
Inoculations are the responsibility of the pet-owner and may be required by the veterinarian.
Ask the veterinarian about any additional charges before the spay/neuter procedure is performed. All services requested unrelated to a routine spay/neuter procedure are the responsibility of the pet-owner.
The veterinarian may charge additional fees that will be the responsibility of the adopter including but not limited to;
if required, SMALL PANEL blood work
vaccinations (distemper, Bordetella, rabies)
Spay/Neuter Consent I have read and fully understand the foregoing Spay/Neuter Contract and agree to be bound to its provisions. By signing my name, I agree to be bound by this agreement. Adopter Name
Vet Clinic That Performed Surgery Please Choose Anheuser Animal Clinic - Bloomsdale Animal House Veterinary Hospital - Arnold Clayton Road Veterinary Hospital - Chesterfield Four Paws Animal Hospital - O'Fallon, IL Franklin County Animal Medical Center Hawk Ridge Animal Hospital Spencer Creek Veterinary - St. Peters Veterinary Care After Adoption
Lucky Chance Rescue covers all necessary veterinary care including age appropriate vaccinations prior to adoption. Which includes;
Minimum 2 Canine Distemper/Parvovirus / Adenovirus Type 1 (Hepatitis) / Adenovirus Type 2 (RespiratoryDisease), Canine Parainfluenza Virus (5 way vaccination)
Minimum 1 Bordetella
Rabies (if older than 16 weeks)
Spay or Neuter
Fecal exam and Wormer (minimum 2 rounds)
Monthly Heartworm and Flea/Tick Preventive Prior To Adoption
Veterinary Examinations Prior To Adoption
All medication to treat any illness diagnosed through our veterinarian
Please sign below to agree to each of the following sections acknowledging the terms of veterinary care after adoption
Upon adoption, adopter is responsible for all future vaccinations, monthly heartworm prevention, monthly flea and tick prevention and all veterinary care from the adoption date forward.
You may use your own vet for any vaccinations required, or please feel free to use our veterinarians. All vaccination due dates and veterinary information are included in the vet care plan. If you did not receive a copy of the vet care plan, please contact your foster or email: firstname.lastname@example.org.
PUPPIES THAT HAVE NOT HAD A MINIMUM OF 3 (THREE) DHPPv VACCINATIONS (distemper / parvo / adenovirus 1 & 2 /parainfluenza virus vaccination) MAY NOT BE IN ANY PUBLIC AREAS! If you adopt a puppy prior to his/her 3rd puppy DHPPv and 2nd Bordetella vaccination or before the puppy vaccination series is completed, they must not have paws on the ground in public areas including but not limited to; pet stores, dog parks, designated dog areas in your neighborhood or a place any other wildlife could expose them to distemper, parvo and other viruses. If adopter does not adhere to this and the puppy gets sick, it is the adopter's responsibility to cover all costs related to emergency and veterinary care. Puppies without all their vaccinations do not have full immunity and are at risk of contracting parvo, distemper, hepatitis, parainfluenza and bordetella.
If the dog is not altered at time of adoption, Lucky Chance Rescue will cover cost of spay/neuter at one of our approved veterinarians, as per our spay/neuter agreement. Any additional services (including age appropriate vaccinations) will be at adopter's expense. You are required to use a Lucky Chance Rescue Veterinarian for spay/neuter and microchip placement
By signing this agreement, adopter agrees they are responsible for all future veterinary care from the adoption date forward. Adopter agrees that The dog will be provided with medical treatment as needed. Adopter agrees to keep all vaccinations current including but not limited to Rabies,
Distemper/Parvo (DHLPP), Bordetella, AND to ensure the Dog receives preventative medication to protect against heartworm disease as well as flea and tickborne illness. You agree to provide the best available care to the dog in a timely manner. Any veterinary problems that may arise, including serious illness requiring emergency care or surgery is your responsibility and you are responsible for all related costs.
PET ADOPTION TERMS & CONDITIONS
Adoption Donations In conjunction with the adoption of this dog I have tendered a donation to Lucky Chance Rescue receipt of which is hereby acknowledged.This donation represents a contribution to defer Lucky Chance Rescue’s expenses both directly and indirectly attributable to the rescue of this and other dogs. Adoption donations are NON-REFUNDABLE after the two week trial adoption. There are no exceptions to this matter unless a Lucky Chance Rescue director provides consent in written form BEFORE thetime of adoption. Adoption donations are tax deductible. Payment can be made by check, cash, Venmo:@luckychancerescue or Paypal: https:// paypal.me/luckychancerescue.
Health and Temperament Lucky Chance Rescue makes no explicit or implicit guarantees in reference to the health and/or temperament of the dog. The Adopter assumes all responsibility for treatments of any and all conditions of physical ortemperament changes that may occur. While Lucky Chance Rescue makes every effort to place only healthy animals, with good temperaments, it cannot guarantee the health of any animal and may not be held responsible for any medical expenses that may be incurred after the date of adoption. The parties hereby acknowledge that Lucky Chance Rescue has not made any warranties relating to the dog, either express or implied, without limitation, any warranties regardinghealth, temperament or whether the dog is housebroken.
Veterinarian Release of Information Adopter understands and agrees that Lucky Chance Rescue shall have the right to contact ANY veterinarian who has examined and/or treated the dog for the purpose of gaining information regarding any aspect of the dog’s health and care including but not limited to; whether or not the dog has received heartworm prevention, heartworm tests, fecal examinations, vaccinations and/or other treatments as required by this contract. Adopter authorizes the release of any information regarding the treatment, training or other interaction of thedog by or with, animal control, law enforcement, veterinarian, trainer, groomer, boarder or any other service provider
Change of Address Adopter agrees to notify Lucky Chance Rescue no less than ten (10) business days prior tochange of address of the Adopter and/or a change of environment that will affect the dog. This will allow Lucky ChanceRescue to update your pet’s registration information so that your pet is fully protected
Care of the Dog You agree that this Dog is being adopted as a family memberand will be given extensive house privileges; i.e. sleep inside the house, be
allowed freedom of the house when the family is home, and will NOT be restricted to the yard at any time. You agree to provide the Dog with fresh water, wholesome dog food, adequate outdoor exercise, affection and shelter. You also
agree that the Dog will not be used as a guard animal, or for any purpose other than as a companion and friend to you and your family.
that she/he will perform her/his obligations under this Agreement in compliance with all applicable laws and regulations.
that she/he is at least 21 years of age.
that neither she/he, nor any person residing with Adoptive Parent or who may have frequent contact with the Dog, has ever been charged with or convicted of any offense related to or involving the abuse, cruelty, neglect, or abandonment of animals.
that she/he will at all times provide the Dog with comfortable, clean indoor housing; high-quality dog food; fresh water; and proper grooming.
that she/he will administer heartworm, flea, and tick prevention medication and will take the Dog to a licensed veterinarian if the Dog requires medical attention, including for routine vaccinations, annual physical exams, and heartworm testing.
that she/he will ensure that that the Dog sleeps comfortably inside Adoptive Parent’s residence and receives adequate social interaction, playtime, and exercise.
that she/he will ensure that the Dog wears a collar with a valid rabies tag and an identification tag containing Adopter's contact information at all times when the Dog is in public or otherwise outside of Adopter's residence.
that the following equipment will not be used on the Dog by themselves, or any person who is handling the Dog: (i) prong training collar, (ii) electric shock collar, (iii) choke collar
that she/he will not, nor will Adopter allow any person to: (i) abuse, neglect, harm, abandon, or otherwise mistreat the Dog in any way; (ii) subject the Dog to experimentation; (iii) rent, lease, loan, or sell the Dog to a laboratory or similar facility; (iv) use the Dog in any form of racing, fighting, or revenue-generating activity for purposes of amusement or entertainment; or (v) subject the Dog to cosmetic surgery or other elective medical procedures (for example, ear cropping, tail docking, or claw removal) unless determined to be medically necessary by a licensed veterinarian.
that the dog will not ride in the back of a pickup truck under any circumstances. Dogs must be tethered in an appropriate dog seat belt or in a crate while travelling in any vehicle.
that during warmer months temperatures can escalate to a fatal level in avehicle within five minutes. Adopter agrees that the dog shall not remain in any vehicle unattended for any length of time.
Disposition of Pet If for any reason the Adopter must relinquish ownership of the dog, owners must contact Lucky Chance Rescue. Adopter further agrees to desist from giving, adopting, loaning, fostering, trading, swapping,abandoning, surrendering or otherwise disposing of or destroying the dog in any manner whatsoever or to any entity whatsoever, unless the dog suffers a catastrophic injury and the treating veterinarian recommends euthanasia. Adopters must give Lucky Chance Rescue 2 weeks to evaluate your dog and find a suitable foster home if dog needs to be returned. All vaccinations must be current at time of surrender. A fine up to $1,000 will be imposed if Lucky Chance Rescue has to recover the dog from anywhere else including but not limited to animal control If the dog becomes lost, Lucky Chance Rescue should be contacted immediately, as we may be able to help in the dog’s recovery. Adopter must make every effort to find their dog.
Forfeiture of Pet
Any breach by Adopter of this contract shall, at the sole discretion of Lucky Chance Rescue, constituteimmediate forfeiture by the Adopter of any and all of the adopter’s interest and. Adopter agrees to return the
dog to Lucky Chance Rescue upon demand. Adopter understands and agrees that there will be no refund of any donationmade to Lucky Chance Rescue in the event of the return to or recovery by Lucky Chance Rescue of a forfeited dog.
*Please note any check returned to Lucky Chance Rescue for insufficient funds is considered to be a breach of contractand will be turned over to the Attorney General’s Office.
We recommend Adopter provides obedience and/or basic training for the dog. When choosing a trainer, adopter agrees to use a professional trainer who uses Least Intrusive positive reinforcement training. Adopter will avoid trainers who use aversive training methods. Aversive training includes alpha rolls, shock collars, prong collars, physical punishment, etc. The following equipment will not be used on the dog or any person who is handling the Dog: (i) prong training collar, (ii) electric shock collar, (iii) choke collar, a physical correction, or a harsh scolding. Lucky Chance Rescue has a list of certified dog trainers using positive reinforment methodology. Adopter will be financially responsible for the cost to complete training.
Liquidated Damages - Legal Expenses Adopter acknowledges that Lucky Chance Rescue has invested substantialmonies, both specifically allocable to this dog and agrees that a requirement of a specific accounting for the cost incurredfor the purpose of rescuing, fostering and rehabilitating and if necessary recovering the dog has been at our expense.Adopter further agrees to reimburse Lucky Chance Rescue for necessary costs and attorney’s fees expended to recoverthe dog, as well as the aforesaid liquidated damages, if the dog is disposed of in any manner by Adopter, or is not returnedto Lucky Chance Rescue by adopter upon demand. Adopter agrees that any and all costs, expenses and/or attorney’s feesincurred by Lucky Chance Rescue to enforce this agreement and/or to recover the dog from Adopter because of Adopter’sfailure to comply with any terms of this agreement shall be paid by Adopter. Adopter also agrees that Lucky ChanceRescue is not responsible for any damages in the home, vehicles or other property after the point of adoption and these expenses are solely the responsibility of the adopter. Please note: If you adopt a puppy prior to his/her 3rd puppy DHPPv and 2nd Bordetella vaccination or before the puppy vaccination series is completed, the dog shall remain inside or in theprivacy of your backyard only. The puppy is not to go in public places, walks in the neighborhood, dog parks, neighbors,friends, etc. He/she is not fully protected from parvo, distemper, parainfluenza. If your puppy does fall ill for any of these reasons, you will be in breach of contract. Adopter agrees to pay for medical treatment, hospitalization, and any other related expenses.
Notifications Any written notification by Adopter required by this contract shall be made by United States mail;postage prepaid to Lucky Chance Rescue. 2303 Flowering Ash Lane, Lake St. Louis, MO 63367. Any contact requiredtelephone notification by Adopter shall be made by calling 636-515-3515 Written and verbal notification shall include thatdog’s name as reflected on this contract, the dog’s microchip number and the Adopters name and address.
Release of Liability and Hold Harmless Clause In consideration of the receipt of the above-referred dog, the Adopterhereby understands, promises and agrees to forever release, discharge, indemnify and covenant to hold harmless LuckyChance Rescue, its directors, officers, volunteers and successors and assigns from any and all claims, damages, costsexpenses, loss of service, actions and causes of action arising out of any act or occurrence relating to the abovereferenced dog from the present time forward.
This is a confidential agreement between the Adopter and Lucky Chance Rescue. Your information will not be shared. Lucky Chance Rescue Representative Signature