In consideration for my receiving: from Rescue Life, Inc. (RLI) on: for the adoption fee of:I hereby agree to care for the animal humanely (including providing adequate food, water, shelter, heartworm preventative and necessary veterinary care) and license it in accordance with the laws and ordinances of the jurisdiction in which I reside. I also agree NOT to sell, trade, or dispose of said animal in any way, but to return it to Rescue Life, Inc. if at any time I wish to relinquish custody. I further agree that said animal shall not be used for medical or any experimental purposes whatsoever, shall not be kept chained or tied, and shall not be attack trained, or used for fighting or breeding purposes. In addition, I agree not to allow the animal to be free to roam the streets or to transport said animal in the back of an open truck, except within a dog crate. It is understood that Rescue Life, Inc. may examine and make inquiry about said animal at any time, and if not satisfied with its’ condition or the conditions in which it is being kept, said animal shall be reclaimed by Rescue Life Inc. immediately.Placement Agent First Last Adopter's Name First Last Adopter's Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Adopter's PhoneAdopter's Email I agree to indemnify and hold harmless Rescue Life Inc., its officers, directors, employees, agents and representatives, for all manner of actions and causes of actions, suits, debts, dues, accounts, bonds, covenants, agreements, judgments, claims, and demands whatsoever arising out of my possession and placements of this animal. I also understand the Rescue Life, Inc. will not be responsible for any medical care (or costs thereof) required after placement of this animal. In addition, Rescue Life, Inc. cannot be held responsible for the conduct, behavior or disposition of this dog after its placement. I hereby warrant that the information given to receive a dog from (RLI) was correct and accurate and that any information given falsely would result in the dog being reclaimed. In the event of violation(s) of the express terms of the agreement it is understood and agreed that the adopter is responsible for any expenses (including possible legal expenses) incurred in retrieval of the animal by Rescue Life, Inc.SignatureDate Signed Unconfirmed and unverified information has been voluntarily provided to Rescue Life, Inc. but (RLI) has undertaken no investigation with regard to the history or physical condition of the dog and makes neither warranty nor guarantee, express or implied, with regard to the physical condition of the dog, its background, or its suitability or compatibility.Special Terms and ConditionsRead the statements below and enter your initials into the adjacent fields.(1) I UNDERSTAND I HAVE SIGNED CONDITIONS BINDING THE ADOPTION OF A DOG FROM RESCUE LIFE AND AGREE TO THEM(2) I UNDERSTAND FOLLOW-UP WILL BE DONE BY RLI TO EVALUATE PLACEMENT(3) I UNDERSTAND THAT IF I CANNONT KEEP THE DOG IT WILL BE RETURNED TO RLIMicrochip NumberNameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.