Heartworm Treatment Contract

Date of Adoption *

Date

Dog Name *

Dog Sex *

Male Female

Dog Age *

Microchip Number

10-15 digit number on vet paperwork

Breed #1 *

Breed #2

Date of Last Heartworm Treatment *

Date

Date of Next Heartworm Treatment *

Date

Type of Heartworm Treatment *

Fast kill (injection) Slow kill (pill)

Heartworm Prevention *

Sentinel Heartgard Trifexis Iverhart ProHeart 6

Date of last Heartworm prevention *

Date

How often to give Heatworm prevention *

HEARTWORM TREATMENT CONTRACT

All medical treatment will be paid for by DHRA (Doghouse Rescue Academy) so long as the adopter keeps up with appointments and medicine as prescribed by the veterinarian. A copy of this adoption contract will be emailed to the Adopter stated in section IV. If the dog is too young to be spayed/neutered and/or vaccinated, DHRA will pay for the vetting from the veterinarian of our choice unless agreed upon otherwise.

The dog that is adopted that is known to be heartworm positive, DHRA will pay for heartworm treatment. At the discretion of the organization, AAUPR agrees to refund the adoption fee or provide another dog without charge if the adopted animal is returned within two weeks of the adoption date. The only treatment that DHRA will pay for is the heartworm treatment:

1) Vet visits for follow up and testing
2) Medicine for treating heartworm

And other medical issues are the responsibility of the owner and DHRA will not be held liable to pay for any other treatment.

Proof of spay/neuter (scheduled appointment confirmation, a spay/neuter certificate, and receipt) should be sent in the form of a scanned document or photo to adopt@doghouserescueacademy.org, please contact Carey at (570) 460-6890 or Dawn at (239) 848-5992 to inform us as soon as possible.

The adopter gives DHRA permission to contact the vet about the well-being of our dog to keep track of medical records.

If the adopter fails to continue with the follow-up treatment given by the veterinarian and/or DHRA staff, we reserve the right to requisition the dog back. Also, let it be known the adoption fee is non-refundable as it is being put towards the care and treatment for the dog.

The spay or neuter should be performed by the indicated date in section I with proof of appointment and receipt for the surgery emailed to adopt@doghouserescueacademy.org unless specified otherwise by the rescue.

If you fail to follow up with the heartworm treatment for the dog by the agreed upon date stated above, this will result in DHRA claiming the animal back into our possession immediately; your adoption fee will not be refunded and you will not be allowed to adopt any animal from our rescue in the future.

By my signature, I attest that I have read the TERMS OF ADOPTION and understand them and agree to them.

I certify that I understand and agree to the above terms & conditions *

BY CHECKING HERE I HAVE READ, UNDERSTAND, AND AGREE TO THIS CONTRACT

Name of Adopter *

First Name Last Name

Email of Adopter *

Please provide the email to send you a copy of your foster/foster to adopt contract

Electronic Signature of Adopter *

Clear

I understand that checking this box constitutes a legal signature confirming that I acknowledge and warrant the truthfulness of the information provided in this document. *

("Acknowledgement") is to let you know that by submitting an electronic signature, you are providing an electronic mark, that is held to the same standard as a legally binding equivalent of a handwritten signature provided by you.

Name of DHRA Representative *

First Name Last Name

Heartworm Treatment Contract

STAFF USE ONLY - DO NOT FILL OUT INFORMATION BELOW