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WHEATEN PLACEMENT AGREEMENT
Click here for a printable .pdf version of this form

DOG’S NAME___________________________________ DATE___________________

SEX_____ NEUTERED/SPAYED_________ AGE_______ AKC REGISTERED_______

I/We agree to adopt the Dog named and described above from Wheatens In  Need Rescue, and to abide by the following conditions and those set forth in the accompanying Conditions of Adoption.

This Dog is a “Rescue Dog”. WIN believes that it is a purebred Soft Coated Wheaten Terrier, but may or may not have an AKC Registration Certification for this dog.  WIN, therefore, can make no representation as to whether or not this Dog is a purebred Soft Coated Wheaten Terrier. 

1.      At the option and expense of the adopter this Dog will be taken to a licensed veterinarian for a thorough health exam within 48 hours from time of adoption.
Known existing health problems at time of adoption:______________________________
_____________________________________________________________________
I/We understanding that the dog named above cannot be returned for a refund for those stated above health problems.

2.      If for any reason I/we cannot keep the Dog, WIN Rescue will be notified IMMEDIATELY.  UNDER NO CIRCUMSTANCES WILL THE DOG BE TAKEN TO AN ANIMAL SHELTER.  NEITHER WILL IT BE GIVEN OR SOLD TO ANOTHER PARTY.  I/We understand WIN Rescue reserves the right to reclaim the Dog pending its re-placement in another home approved by WIN, and that if this is necessary after the first 30 days, all adoption fees are forfeited in the interest of finding the Dog a good, permanent home. ____            

3.      This Dog has been Spayed/Neutered.  I understand that a spayed/neutered dog cannot give birth or father puppies.                                                                                                                               

4.      I/We agree that the information contained in the Application for Adoption is still true and correct and that any breach of the application shall constitute a breach of the Agreement.                                        ______

5.      I/We understand that this is a “Rescue Dog”.  I/We understand that WIN has no information concerning this Dog or the conditions under which he previously lived other than what was provided by the prior owner/care taker.  No representations concerning this Dog, except as contained in this contract or its attachments; have been made to me.                                                                                                                               

6.      I/We understand that upon breach of the contract, the Dog will immediately be returned to WIN and that all rights shall cease immediately.  Further, WIN retains the right to seek damages for obtaining the return of the Dog, for placing/euthanizing the Dog and for reasonable attorney’s fees and costs.                 ______

I HEREBY CERTIFY THAT ALL THE INFORMATION CONTAINED ON THIS FORM IS TRUE AND CORRECT.  I AGREE TO KEEP THIS SOFT COATED WHEATEN TERRIER EXCLUSIVELY AS A PET AND NOT FOR RESEARCH.  I ACCEPT FULL RESPONSIBILITY FOR HIS/HER CARE, RELEASING THE OWNER, AS WELL AS WHEATENS IN NEED AND IT’S REPRESENTATIVES, OF ANY LIABILITY CONCERNING THIS WHEATEN.

Agreed to by:_____________________________________________________________
                     Signature
Printed Name:_____________________________________________________________ Address:_________________________________________________________________ City _____________________State______ Zip _________________
Business Telephone:____________________ Residence Telephone___________________

The adoption fee is $425 for a puppy age 1 year or younger and decreases on a sliding scale thereafter.  The adoption fee for a dog 7 years and older is $275.  You will be advised about the amount of the adoption fee by a WIN volunteer.  The adoption fee is due upon your acceptance of this Placement Agreement. 

Please make checks payable to Wheatens In Need (a 501c-3) non-profit corporation.