ADOPTION CONTRACT #:  ________________                              DATE:  __________________________________________

AKITA’S NAME:  _______________________________________________________________________________________________

AGE:  ____________   SEX:  _____________  COLOR/MARKINGS: ___________________________________________________

SPAYED/NEUTERED:  _____________ HW TEST:  _________ FECAL:  _______ WORMING: ___________ DUE:  _____________

DATE OF LAST VACCINATIONS: DHLP:  ________________  PARVO:  ____________________  RABIES:  __________________

TATTOO #:  __________________________  RABIES TAG #:  ____________________________   STATE:  __________________

In consideration of the Akita Rescue of Western New York, Inc. (ARWNY) allowing me (us) to adopt the above mentioned Akita as our pet in accordance with ARWNY conditions, I (we), the undersigned, agree to all of the following terms of this contract and understand that noncompliance with the terms of this agreement or falsification of the application gives ARWNY the right to reclaim this Akita through whatever means necessary without refund of the adoption donation. 

1. To give Akita _____________ weeks to adjust to new surroundings. 

2. To return Akita only to ARWNY if unable to keep, at adopter’s expense. 

3. To never take this Akita to an animal shelter, pound, or humane society. 

4. To never allow this Akita to be used in animal research. 

5. To never allow this Akita to be used in DOG FIGHTING. 

6. To never allow this Akita to be used for protection training of any kind. 

7. To treat this Akita as a family pet, with affection and kindness and never subject this Akita to abuse or cruelty at any time. 

8. To never leave this Akita alone chained or tied up, either indoors or outdoors under any circumstances.   This Akita must be leashed unless in a secure, fenced yard. Due to the inherent temperament of the Akita, dog parks are not an acceptable place to allow this Akita off leash.

9. To treat the Akita as a house pet, and not kept outdoors all the time. 

10. To provide this Akita with shelter from sun and bad weather, a fenced yard or enclosure, and clean water when outdoors. 

11. To maintain this Akita for the rest of its natural life on a high-quality food, preferably all natural and soy-free, or as otherwise directed by a veterinarian. 

12. The dog has been fully vet checked and/or wormed prior to adoption.  Once adopted, the new owner is responsible for all ordinary and extraordinary vet care.  The adopter agrees to provide regular veterinarian care when necessary, including annual vaccinations, parasite checks, dental care, and to maintain this Akita on heartworm preventative (no Ivermectin; Interceptor okay).  If this is not done, ARWNY reserves the right to reclaim the dog.

13. ARWNY will fully disclose any known health problems prior to adoption.  ARWNY is not responsible for any genetic / hereditary defects evident after adoption.

14. Should this Akita die from unknown causes, the adopter is requested to have the dog autopsied at the adopter’s expense and provide results to ARWNY in order to help the breed. 

15. To immediately license, put and keep personal/rescue I.D. tags on this Akita at all times, with a strong collar, preferably a rolled leather one. 

16. To notify ARWNY if I move and give my new address and home telephone number. 

17. If this Akita is lost or stolen, to notify ARWNY immediately by telephone and to make every effort to locate the dog, including placing ads in local papers and regularly checking all local pounds and shelters by telephone and in person. 

18. The adopter agrees to allow representatives of ARWNY to periodically visit and check on this Akita to be assured of compliance with all of the items in this contract. 

19. The adopter agrees to pay a  suggested _____________ Adoption Donation upon receipt of this Akita. This is refundable during the adjustment period upon return of this Akita, but at no time thereafter. 

20. The adopter agrees to pay a minimum of $30.00 handling charge to ARWNY on all returned checks. 

21. The adopter agrees to be responsible for any and all legal fees incurred if a violation of this contract results in a legal action. 

22. The adopter and Akita Rescue agree that the actual value of the Akita is $600.00. 

AKITA RESCUE does not usually recommend that an Akita of more than one year of age be adopted into a home where there are children of less than teenage years. This recommendation is based on ARWNY’s past experience. 

The Akita is known to be aggressive to other dogs, especially dogs of the same sex, and is known to be aggressive to cats and other animals. 

The Akita displays primitive canine behavior patterns at times. When given harsh correction, the Akita may respond to interpreted aggression with aggression. 

The adopter has read and understood the Information Package given to him/her detailing health and behavior characteristics in the Akita breed.


The undersigned adopter has been advised of these facts and agrees to accept all responsibility for the behavior of the Akita chosen for adoption, and agrees to ALL CONDITIONS of this contract. 


In consideration of ARWNY allowing me/us to adopt this Akita as our pet, I/we promise and agree to be solely responsible for this animal and to indemnify and hold harmless the AKITA RESCUE,its Board of Directors, Officers, Agents, Members, and Volunteers from any and all claims of liability for the conduct of this Akita on or after the date of this adoption.

 The undersigned (s) further agree (s) and intend (s) that this RELEASE OF LIABILITY AND 
INDEMNIFICATION shall apply to all known, unknown, and unanticipated damages resulting
from my/our adoption, ownership, or control of such animal.


Signature of adopter (s):  _____________________________________________________________________________________

Signature of adopter (s):  _____________________________________________________________________________________

Name (s):____________________________________________________________________________________________________

Name (s):____________________________________________________________________________________________________

Street address:   _____________________________________________________________________________________________

City:   _______________________________________________________________________________________________________

State:  ______________________ Zip Code____________  Driver's License Number & State: ___________________________

Home Telephone: ____________________________________
Work Telephone:  ______________________________________

Signature of ARWNY representative:

  Additional Waivers/Stipulations by ARWNY:
ARWNY representative initials:______________  Adopter (s) initials:   _____________

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Updated: 01/22/2009

Akita Rescue of Western New York, Inc.

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