The following puppy of the Border Collie breed that you are purchasing has a health problem.

COLOR: ____________________________ SEX: ______________

LITTER REG. NO.: ______________ DOB: ______________

MARKINGS: ________________________________________________________

SIRE: ____________________________ SIRE'S ABC REG. NO.: ______________

DAM: ____________________________ DAM'S ABC REG. NO.: ______________

It is not, in our opinion, a significant health risk to delay you from taking the puppy home. It is on medication from the Veterinarian that signed the health certificate. The medication it is on is:

________________________________________________________

________________________________________________________

________________________________________________________

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for:

________________________________________________________

________________________________________________________

________________________________________________________

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If there are any other problems that you see, or if the condition seems to be getting worse, please contact the Veterinarian designated on the Health Certificate.

This disclosure is being made to you because Fl. Stat. §828.29 states that the examining veterinarian warrants that the animal has no sign of contagious or infectious diseases.

By my signature below, I understand that the puppy is being treated for the above stated condition(s) and __________________ (breeder) will assume responsibility for the completion of the treatment at his designated veterinarian for two weeks from the date and time of signature below.

This is part of the contract between the Purchaser and Seller.


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Date and Time of Signature

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Seller

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Purchaser

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Co-Purchaser

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Witness to the Agreement