Dog Adoption Application Form
For additional copies of this form, please go to http://pitcrewpitrescue.blogspot.com/ For more information about our rescue and our dogs available for adoption, please visit the above website or visit us on Facebook at http://www.facebook.com/pages/Pit-Crew-Pit-Bull-Rescue/100379740064601
Contact Information
Full name: ______________________________________________________________
Occupation: ______________________________________________________________
Address: ______________________________________________________________
How long at this address: ___________________________________________________
Cell Phone: _______________________________________________________________
Work Phone: ___________________________________________________________
Home Phone: __________________________________________________________
Best time to call: ___________________________________________________________
Email address: __________________________________________________________
Family & Housing
How many adults are there in your family (their relationship to you)?
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How many children (ages)?
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What type of home do you live in single family, town home, apartment, farm, etc.?
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Please describe your household: __ Active __ Noisy __ Quiet __ Average
If you rent, please give the rules governing pets and the landlord’s name and number:
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(By providing this information you are allowing PCPBR to contact your landlord. If requested, please let your landlord know they will be receiving a call from us so they will speak to us.)
Have you owned a pit bull or pit bull mix type of dog before? Are you familiar with the breed? If so, how are you familiar with the breed? Would you like to receive more information about the breed? ________________________________________________________________________________
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Does anyone in the family have a known allergy to dogs? _________________________
Is everyone in agreement with the decision to adopt a dog? _________________________
Do you have time to provide adequate love and attention? _________________________
Other Pets
What other pets do you have (specify type and number)?
Are these pets up to date on vaccines? _________________________________________
Are these pets spayed/neutered? If not..why?____________________________________
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Do you provide your pets with monthly heartworm preventative? (Interceptor, Heartgard, etc.) ___Yes ___No
Do you provide your pets with monthly flea and tick preventative? (K9 Advantix, Frontline, etc.)
___Yes ___No
Have you every surrendered a pet? If so, why?
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Have you ever had a pet euthanized? If so, why?
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Have you ever lost a pet to an accident?
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How do you discipline your pets and why?
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Veterinarian
Do you have a regular veterinarian? __ Yes __ No
Veterinarian’s name: _______________________________________________________
Clinic Name: _______________________________________________________
Clinic Address: ________________________________________________________
Clinic Phone: ________________________________________________________
(Providing PCPBR with this information you are allowing PCPBR to call your vet. If requested, please authorize the release of information to PCPBR.)
About the Dog You Wish to Adopt
What is your idea of an ideal dog and why?
Desired age: __________ Desired Size: _____________________________________
Breed you would not adopt:_____________________________________________________
Desired sex: _ Spayed Female _ Neutered Male _ No preference
Willing to adopt: __ outgoing/hyper dog __ shy dog
__ dog that needs regular medication __ dog that needs training
__dog that needs regular exercise __ dog that is not child friendly __dog that is aggressive to other animals __dog that must be the only dog in the home
__ None of these
Where will the dog spend the day? (describe)
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Where will the dog spend the night? (describe)
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Do you use crate training? ___Yes ____No Are you willing to purchase a crate for the dog you wish to adopt if you do not already have one? ___________________________________________________________________________
Number of hours (average) dog will spend alone during a typical weekday? Typical weekend? _____________________________________________________________________________
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Will you take the dog to an off-leash dog park? ___Yes ___No If yes, do you agree to cease dog park visits if the dog shows aggression toward any other dog or human? ____Yes ____No
Who will have primary responsibility for this dog's daily care? _______________________
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Who will have financial responsibility for this dog? ________________________________
Do you agree to provide regular health care by a Licensed Veterinarian? This includes keeping the dog up to date on vaccinations as well as basic medical care. __ Yes __ No
Do you agree to provide the dog with monthly heartworm preventative? (Interceptor, Heartgard, etc.) _____Yes _____No
Do you agree to provide the dog with monthly flea and tick preventative? (K9 Advantix, Frontline, etc.) ____Yes ____No
Do you agree to keep the dog as an indoor dog? __Yes __No
When the dog goes out, how do you plan to supervise it? Fenced yard? Do you use tethering?
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Do you agree to contact PCPBR via phone call to (919) 457-3719 or by e-mail to pitcrewpitbullrescue@gmail.com if you can no longer keep this dog? __Yes __No
Are you familiar with microchips? If the dog you wish to adopt has a microchip, do you agree to register your contact information on the proper website? ___Yes ___No
Are you be willing to let a representative of PCPBR visit your home by appointment prior to approval of adoption?
__Yes ____No
__Yes ____No
If we have discussed the dog, cat, or human aggression problems with the dog you wish to adopt, do you agree to always supervise the dog around other animals and people? (If we have not discussed this issue, please check N/A.) ____Yes ____No ____N/A
How did you hear about PCPBR? ___________________________________________________________________________
Would you be interested in fostering? __Yes __No ____I would like to know more about fostering. If yes, would you want to foster a puppy or an adult dog? ________________________
Personal References
Please list someone who is familiar with both you and your pets. Please inform your references that they will be receiving a call from us!
Name:
Address:
Phone:
Relationship (relative, neighbor, friend, etc.):
Name:
Address:
Phone:
Relationship (relative, neighbor, friend, etc.):
All of the information I have given is true and complete. This dog will reside in my home as a pet. I will provide it with quality dog food, plenty of fresh water, indoor shelter, affection, annual physical examination and vaccinations under the supervision of a licensed Veterinarian.
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(Signature*) (Date)
*If you are filling this form out in a word document, please type your name in the signature box.
