Application for Adoption

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)?

_________________________________________________________________________

How many children (ages)?

_________________________________________________________________________

What type of home do you live in single family, town home, apartment, farm, etc.?

_________________________________________________________________________

Please describe your household:  __ Active    __ Noisy    __ Quiet   __ Average

If you rent, please give the rules governing pets and the landlord’s name and number:

________________________________________________________________________________

________________________________________________________________________________

(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?____________________________________

_________________________________________________________________________

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?

_________________________________________________________________________

Have you ever had a pet euthanized? If so, why?

_________________________________________________________________________

Have you ever lost a pet to an accident?

_________________________________________________________________________

How do you discipline your pets and why?

_________________________________________________________________________

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? _____________________________________________________________________________

_____________________________________________________________________________

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?  _______________________

___________________________________________________________________________

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

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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