For
official use only.
Name of
Basenji: _________________________________ Age:_______________
BRAT Tag
Number (if available):_______________________
Basenji
Purebred: _____ Basenji Mix: _____ Other: _____
Color: (
) Red/White ( ) Black/White ( ) Tri-Color ( )
Brindle ( ) Other ________
Sex: (
) Male ( ) Female
Basenji
Rescue and Transport, Inc., a Texas non-profit corporation
(BRAT), has established this Contract to detail the specific
requirements to which the Adopter must comply as a condition of
the Foster/Adoption of the rescue Basenji (referred to herein as
the "Basenji") whose name and description appear above.
This is an agreement between the
owners of the Basenji, Basenji Rescue & Transport, Inc.,
("BRAT,") and the individuals who are entering into this
Foster-to-Adopt Contract ("the foster home" or "the foster
family"). In consideration of the mutual promises contained
herein, the parties agree as follows:
The foster family agrees to pay a
security deposit of ____________ in exchange for possession of
the Basenji. Said security deposit will convert to an adoption
fee any time during the month-long foster period (or some later
date) if BRAT and the foster mutually agree that an adoption
will go forward. A refund of the security deposit will be made
if the Basenji is placed for adoption or foster in another home.
The foster family understands and
agrees that it has NO RIGHT to keep the Basenji unless BRAT
agrees that an adoption will proceed. The BRAT Adoption Contract
is incorporated into this contract by reference. A completed
copy of the BRAT Adoption Contract is attached as Addendum A and
should be signed and returned along with this Foster-to-Adopt
Contract. Addendum A will be marked “Void” by BRAT and a copy
returned to the foster family if the determination is made that
an adoption will not proceed.
The following conditions apply
to the fostering of BRAT's Basenjis while in the foster home.
Please print out this form, initial each clause individually,
and sign and date the bottom of the form.
____ 1) The Basenji remains the
property of BRAT and must be immediately surrendered upon
request by an officer of BRAT. If it is necessary for BRAT to
take legal action to recover the Basenji or otherwise enforce
provisions in this agreement, I/we will pay all court costs and
legal fees incurred if BRAT prevails in the legal action.
____ 2) Veterinary care will be
reimbursed by BRAT if the foster family obtains prior approval.
Reimbursable veterinary care may include vaccinations, heartworm
testing and heartworm preventative, spay/neuter and any
prescription medications necessary for the Basenji for the
duration of the fostering period. The foster family shall be
responsible for transporting the Basenji to and from the vet for
scheduled checkups and any other treatment necessary.
Transportation shall be at the foster home's expense.
____ 3) All expenditures incurred by
the foster family, other than emergency care and emergency
treatment, require prior approval by BRAT. In the event the
Basenji is adopted by the foster home, BRAT will not reimburse
or refund any expenditure unless agreed upon prior to the
expenditure (other than the previously referenced emergency
care).
____ 4) Unless being walked on a
leash, the Basenji will be kept in the foster home or in a
fenced yard located at the foster home at all times during the
day and in the foster home at night.
____ 5) The Basenji must be provided
with appropriate food and water; housed in the foster home; and
exercised outside in either in a secure, fenced yard or walked
on-leash.
____ 6) Questions or problems are to
be directed to the BRAT coordinator named at the end of this
document. If there is a need to remove the Basenji from the
foster home, the Basenji is only to be given directly to a
representative of BRAT designated by the BRAT coordinator.
____ 7) The foster family accepts
responsibility for any and all events that occur in connection
with the fostering of a rescue animal, including, but not
limited to: any damage to the foster home caused by the Basenji
and any liability for actions of the Basenji towards the foster
family or any third parties with which the Basenji comes into
contact while in the foster familiy’s care. The foster family
agrees to release, defend, indemnify and otherwise hold BRAT
harmless from any and all claims, known and unknown, now or
hereafter, arising in connection with the Basenji.
____ 8) BRAT believes it very
important that the foster family have a crate or other means of
confinement available should the foster home need to leave the
Basenji home alone. Basenjis left unrestrained can be very
destructive. The foster family hereby specifically and forever
releases, discharges and holds harmless BRAT, its agents,
and all other persons, firms or corporations charged or
chargeable with liability, their heirs, administrators,
executors, successors and assigns, from any and all claims,
damages, costs, expenses, loss of service, actions and causes of
action belonging to the foster family, arising out of any act or
occurrence arising after the execution of this Foster-to-Adopt
Contract, and particularly on account of the fostering of the
Basenji.
_____9) The foster to adopt family
warrants that, with the addition of the Basenji to the foster
home, the number of animals in the foster home complies with all
local and state ordinances and statutes.
____10) If any provision of this
agreement is or becomes unenforceable, or void by force or
operation of law, the other provisions shall remain in full
effect, valid and enforceable.
____ 11) Each and every clause, in
its entirety, has been read and understood by the foster family.
By signing this document the foster family agrees to adhere to
the terms and conditions.
____12) The foster family affirms
that it has never been charged with animal cruelty.
Date:_____________________
Signature of foster family:_______________________________________
Name:
_________________________________________________________
Street Address:
__________________________________________________
City:
___________________________State:______ Zip Code:____________
Date:________________
Signature of foster family:_______________________________________
Name:_________________________________________________________
Street
Address:__________________________________________________
City:___________________________State:______ Zip
Code:____________
Area Code/Phone
Number:__________________________________________
THIS CONTRACT MUST BE SIGNED BY
ALL ADULT MEMBERS OF THE FOSTER HOME. TO THE EXTENT ADDITIONAL
SIGNATURES ARE REQUIRED, PLEASE ATTACH AN ADDITIONAL SIGNATURE
PAGE.
Signature of authorized agent of
Basenji Rescue & Transport, Inc:
________________________________________________________________
Name:
__________________________________________________________
Position:
________________________________________________________
Street Address:
__________________________________________________
City:
__________________________State:______ Zip Code:_____________
Area Code/Phone
Number:__________________________________________
Please return this signed contract
to:
B. Ann Hageman
321 W. View Street
Lombard, IL 60148
Email: b.ann321@comcast.net
BRAT Web Site:
http://www.Basenjirescue.org
Coordinator to contact with questions:
Name:__________________________________
Phone:_________________________________
Email:__________________________________