I agree to provide a loving home for                                             and medical care when needed.  This will also include having said animal spayed/neutered at the appropriate age.

I understand that LAKE HAVEN cannot guarantee the health or the temperament of this animal and hereby release LAKE HAVEN from all liability once the animal is in my possession.

Date                                                                              Signature                                                                    

Donation Amount                                                        Address                                                                        

                                                                                        Phone