Name of receiving rescue organization

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Receiving Rescue EIN

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Name of pet being transferred

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Type of pet being transferred

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Breed of pet being transferrer

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Color of pet being transferred

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I am an authorized representative of the nonprofit rescue organization listed above and the organization is exempt from federal income taxation under subsection 501(a) and described in subsection 501(c)(3) of the Internal Revenue Code

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All pets adopted or transferred to me on behalf of the organization listed above, including the pet(s) identified and described above (hereinafter referred to as the pet) will not be bred and will be spayed or neutered prior to being adopted into a permanent home unless the spay or neuter is contraindicated in writing by a licensed veterinarian.

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I agree that PPITS has disclosed all known health issues at the time of transfer. I further agree that PPITS is in no way responsible for any medical or other expenses I incur once the transfer is complete. Should a health problem or injury arise, I agree to seek immediate medical treatment for the pet at my own expense.

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I understand that the pet(s) may have health or behavioral concerns about which PPITS is unaware. I further understand that PPITS is unaware of exact age, breed, prior registration, prior training, etc. PPITS makes no guarantees or express or implied warranties of any kind regarding the pet(s).

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I agree that after the transfer is completed for the pet(s) that I take full responsibility for any behavioral problems it may have that may result in the pet(s) causing damage to any property owned by myself or others. I agree to indemnify and hold harmless PPITS and any of its affiliates, associates and volunteers against liability from any such damages caused by the pet(s).

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Upon transfer of the pet(s) listed above, PPITS will provide me with all veterinarian records including rabies and alteration certificates and microchip information (if available at the time of transfer) for the pet(s)

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I agree that the pet(s) is to be returned to PPITS if I am unable to keep him/her due to ANY circumstances. I agree not to surrender the pet(s) to any animal shelter/rescue or give away the animal for free.

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LIABILITY WAIVER: I hereby waive, release, and discharge any and all claims and damages for personal injury, death, or property damage which I may sustain or which may hereafter accrue as a result of any negligence or misconduct of PPITS. I agree to indemnify and to hold free and harmless PPITS, its Directors, Officers, and/or agents, including their heirs, agents, representatives, successors and assignees from any and all injury and/or property damage, claims, losses, liability, damage, expenses, fees including attorney fees, costs, and judgments that may be asserted against PPITS which I may incur or sustain or that result from the acts or omissions of PPITS its employees and agents or acts, negligence, or omissions on my behalf. I hereby confirm that all the above information is true and correct. I understand that submission of this application does not necessarily mean that I will be approved for adopting and that Paw Prints in the Sand Animal Rescue reserves the right to reject any applicant. I authorize you to verify any and all information set forth in this application and contact my personal references. Your electronic signature below confirms all information provided is true and accurate and you agree to our adoption policies set forth above. PLEASE TYPE YOUR INITIALS IN THE SPACE BELOW TO ACKNOWLEDGE AND AGREE TO OUR LIABILITY WAIVER.

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