Step 3 - Liability Form

[THESE FORMS ARE DESIGNED TO PROTECT THE ADOPTIVE DOG FROM EVER BEING HOMELESS OR MISTREATED OR PUT IN JEOPARDY IN ANY WAY. WE HOPE YOU AGREE THAT THIS IS IN THE BEST INTEREST OF THE DOG.]

If there is not a representative listed for your region or state, contact one of the following people for assistance, assuming you haven't been contacted after 2 weeks from submission of your electronic Application:

Helen Z. Brown - lhasas@bkvsp.com 814-624-5136 Northeast & Midwest
Vickie Kuhlman - NorthTwin@aol.com West & Southwest

Because we depend soley on volunteers and we do not have coverage in all areas of the country, it is possible that your adoption process and approval may be delayed or even be geographically impossible. The more active volunteers we have, the more efficient our ability to respond to the needs of the dogs and the adopters will be. Please consider volunteering. Thank you for your patience and understanding throughout the process!

The Contract & Liability Release forms cannot be Emailed, they will be picked up by the representative conducting the home visit. Applications are submitted electronically.

AMERICAN LHASA APSO CLUB RESCUE RELEASE OF LIABILITY AND INDEMNIFICATION

In consideration of the AMERICAN LHASA APSO CLUB RESCUE allowing me/us to adopt this Lhasa as my pet, I/we agree to be solely responsible for this animal and to indemnify and hold harmless the AMERICAN LHASA APSO CLUB RESCUE and its board of directors, members, officers, and agents from any and all claims of liability by myself/ourselves or third parties for the conduct of this Lhasa on or after the date of this adoption.

The undersigned further agree[s] and intend[s] that this RELEASE OF LIABILITY AND INDEMNIFICATION shall apply to any damages resulting from my/our adoption, ownership, or control of such animal.

This document incorporates all the information provided in the Adoption Application & Contract.

I/We have read the foregoing and agree with all provisions and stipulations stated herein.

THIS IS A BINDING CONTRACT, ENFORCEABLE BY CIVIL LAW. If the above statements are found to be fraudulent or untrue, we reserve the right to repossess the dog and all liabilities are waived.

SIGNATURE (Must be signed by all adults in household responsible for this Lhasa).
Below is a copy of the Liability Form, click here for a PDF copy to fill out (opens in a new window).


Name (Print)____________________________________________ Date____/____/____

Name (Print)____________________________________________ Date____/____/____

Signature___________________________ Signature______________________________

Address___________________________ City_____________________

State/Canadian Province______________________ Zip__________

Phone (home)_______________________ Phone (work)_____________________ext____

Phone (home)_______________________ Phone (work)_____________________ext____

Driver's License #________________________ License Plate#__________________________

Driver's License #_______________________ License Plate #_________________________


Agent, AMERICAN LHASA APSO CLUB RESCUE

_________________________________________ Date____/____/____

Finally the Application