I (We) _____________________________________________, hereby agree to provide a caring home for this (color & sex)_______________ Brussels Griffon known as ________________, age __________. I understand that this Griffon has been spayed or neutered and is heartworm negative. I accept full responsibility for her/his health, welfare and actions. Should I (we) at any time be unable to keep or care for this dog, I (we) will NOT give her/him away or sell her/him to anyone or destroy (euthanize) this dog, but will contact Pam Gerstner, Rescue Coordinator or another Rescue Representative to help in finding her/him a new suitable home. I (we) also agree to the following:

1. A 30 day evaluation period exists to determine the compatibility of this Griffon in our home.
   
   
2. To keep this dog's vaccinations up to date, and if sick, to take this dog to a qualified veterinarian.
   
   
3. To provide inside housing at all times. At no time will this Griffon be housed out of doors.
   
   
4. To test this dog annually for heartworm and keep him on heartworm preventative during warmer months - or year round if so advised by a qualified veterinarian.
   
   
5. To provide an adequate amount of quality food and fresh water to maintain this dog in good health, and to groom her/him or have her/him groomed, regularly to maintain her/his health and comfort.
   
   
6. To never physically or emotionally abuse or let her/him be abused by any other person or animal.
   
   
7. To always keep her/him on a leash when she/he is not in a fenced area. To never leave her/him unattended while she/he is tied up or in a car. To transport my Griff in a crate while in a car, as I understand that Griffs are known to bolt and escape when a car door is opened.
   
   
8. To treat her/him with love, affection and kindness.
   
   
9. If she/he is ever lost, stolen or deceased, to immediately, within 24 hours, contact a Brussels Griffon Rescue Representative.
   
   
10. To donate $__________ to National Brussels Griffon Rescue, Inc.to help defray the cost of this adoption and other rescues. (This donation is tax-deductible to the extent allowed by law.)
    
    
11. To pay for transportation of the rescue Griffon to his/her new home if this is necessary, and to be responsible for arranging this transfer.
    
    
12. To notify the Program Coordinator of any change of address or location where the dog is being kept.

This contract is between the adoptive person(s) and the member of the NBGR representing this rescue dog. The members of the Brussels Griffon Rescue are members of the NBGR, Inc., however, the National Brussels Griffon Rescue, Inc. is in no way financially liable or responsible for this adoption or future acts of the rescue dog. In signing this contract, the adopting person(s) agrees to hold the members of the National Brussels Griffon Rescue, Inc. and those acting on its behalf harmless from any liability, expense or cost of defense resulting from acts of this dog and all problems, consequences or disputes resulting from the adoption of this Brussels Griffon.

My signature acknowledges that I have read and understand this contract and agree to all the above conditions. I understand that the National Brussels Griffon Rescue, Inc. may reclaim the above named Griffon from me if I do not fulfill this agreement.

Signed: (Person[s] Adopting Griffon)________________________________________

Address:_____________________________________________Date________________

City:__________________State:_____________Zip:__________Phone:__________________

Email Address:________________________________________________________________

Signed: (NBGR, Inc. member representing this dog)_________________________Date:____________