top of page

LAKE COUNTRY SPCA 

11764 HWY 15 

CLARKSVILLE, VA 23927 

PHONE# 434-374-8076, FAX# 434-374-8078,

EMAIL: LAKECOUNTRYSPCA@YAHOO.COM

ADOPTION CONTRACT 

(ALL HIGHLIGHTED AREAS ARE TO BE COMPLETED AT THE SHELTER)

NAME:                                                                                                                     DATE:

 

ADDRESS:

 

CITY:                                                            STATE:                                                                          ZIP:

 

HOME:                                                                     CELL#1:                                                    CELL#2:

 

EMAIL:

                                                                                                                                

REFERENCE NAME:

​

HOME#:                                                                                                                                     CELL#:

 

REFERENCE NAME 2:

 

HOME#:                                                                                                                                     CELL#

 

VETERINARIAN NAME PHONE#:

LOG#:                                                          ANIMAL:                                                                 NAME AGE:

​

( CAT        DOG          )             ( M        F       )            ( NEUTERED       /SPAYED        )         ( NOT NEUTERED/SPAYED          )

​

BREED:                                                                                                  COLOR:

 

THIS ANIMAL WILL REACH APPROXIMATELY (6) MONTHS OF AGE ON:

*STATE LAW SECTION 3.2-6574 OF THE CODES OF VIRGINIA REQUIRES INDIVIDUALS WHO ADOPT A DOG OR CAT. 

TO HAVE THE ANIMAL STERILIZED BY A LICENSED VETERINARIAN WITHIN THIRTY (30) DAYS OF THE ADOPTION, OR, IF THE ANIMAL IS LESS THAN SIX (6) MONTHS OLD, WITHIN THIRTY (30) DAYS AFTER IT REACHES SIX (6) MONTHS OF AGE, NO LATER THAN                                                                                . 

*ANY PERSON WHO VIOLATES THIS ARTICLE IS SUBJECT TO A CIVIL PENALTY AND THE NEW OWNER MAY BE COMPELLED TO COMPLY WITH THE PROVISION OF THIS ARTICLE. 

*LAKE COUNTRY SPCA REQUIRES A COPY OF THE SPAY/NEUTER CERTIFICATE BE MAILED OR FAXED FOR OUR RECORDS. 

​

​

​

I UNDERSTAND AND ACCEPT THE SPAY/NEUTER LAW STATED ABOVE. 

​

 

NAME:                                                                                                  

 

SIGNATURE:                                                                           DATE:     

 

 

 THE LAKE COUNTRY SPCA AGREES TO THIS ADOPTION SUBJECT TO THE FOLLOWING TERMS AND CONDITIONS: 

​

*I WILL ABIDE BY THE ANIMAL LAWS OF VIRGINIA, CODE 3.2-6503. CARE OF COMPANION              ANIMALS. 

*THIS ANIMAL SHALL NOT BE MISTREATED, NEGLECTED, OR ABANDONED.  IF I AM 

  UNABLE TO CARE FOR THIS ANIMAL, I WILL PROMPTLY CONTACT THE LAKE COUNTRY   SPCA.  I         UNDERSTAND THERE MIGHT BE A WAITING PERIOD CONTINGENT ON   AVAILABLE SPACE 

*THIS ANIMAL WILL NOT BE SURRENDERED TO A KILL SHELTER AND/OR ANIMAL CONTROL SHELTER. 

*THIS ANIMAL WILL NOT BE USED OR SOLD FOR MEDICAL OR EXPERIMENTAL PURPOSES OF ANY             KIND. 

*THIS ANIMAL WILL NOT BE USED IN CONNECTION WITH DOG FIGHTS, ATTACK TRAINING, OR ANY OTHER CRUEL SPORT OR GAME. 

*THIS ANIMAL WILL NOT BE RESOLD FOR PROFIT. 

*I WILL PROMPTLY NOTIFY THE LAKE COUNTRY SPCA IF THE ANIMAL IS LOST. 

*I UNDERSTAND FULLY THE LAKE COUNTRY SPCA DOES NOT WARRANT OR GUARANTEE   CONDITION, BEHAVIOR, PRIOR OWNERSHIP, BREED, AGE OR SIZE. 

*THE LAKE COUNTRY SPCA HAS THE RIGHT TO REFUSE ANY ADOPTION. 

*THE LAKE COUNTRY SPCA HAS THE RIGHT TO VISIT AND CHECK ON THE WELFARE OF                       

  THE ANIMAL.  IF ANY PROVISION OF THIS CONTRACT OR ARTICLE OF THE “ANIMAL 

  LAWS OF VIRGINIA”, CODE 3.2-6503 HAVE BEEN VIOLATED, A LAKE COUNTRY SPCA   REPRESENTATIVE AND/OR COUNTY ANIMAL CONTROL OFFICER HAVE THE RIGHT TO   REPOSES THE ANIMAL. 

 

BY SIGNING THIS CONTRACT, I ACKNOWLEDGE RECEIVING THE ANIMAL DESCRIBED ABOVE 

AND CERTIFY THAT I HAVE READ AND FULLY UNDERSTAND THIS AGREEMENT AND DO HEREBY AGREE TO ABIDE BY THE TERMS, CONDITIONS, AND “ANIMAL LAWS OF VIRGINIA” CONTAINED HEREIN.  I HAVE RECEIVED A COPY OF THESE FOR MY RECORDS.

​

​

ADOPTER SIGNATURE:                                                                                                    DATE:                                                                

 

SPCA REPRESENTATIVE SIGNATURE:                                                                                                                                                     

 

DONATION (NON-REFUNDABLE) $                                                 ADDITIONAL DONATION$                                                     

​

ANIMAL ABUSE STATEMENT 

 

I CERTIFY THAT I HAVE NEVER BEEN CHARGED WITH, OR FOUND GUILTY OF ANIMAL CRUELTY, NEGLECT, OR ABANDONMENT OF ANY KIND. I ALSO CERTIFY THAT NO ANIMAL HAS EVER BEEN REMOVED FROM MY CUSTODY DUE TO ABUSE OR NEGLECT OF ANY KIND. 

​

NAME:

 

SIGNATURE:                                                                                                                               DATE:                                                          

bottom of page