Please read our important adoption information before filling out this form!

Adoption Application

First Name *

Last Name *

Address *

City *

State * AL AK AR AZ CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip/Postal Code *

Home Phone Number *

Work Phone Number

Cell Phone Number

Email Address *

How old are you? *

What is your occupation? *

How many adults 21 and over live in your home? Who are they in relation to you? *

How many individuals under the age of 21 live with you? What are their ages? *

Do all the members of your household want to adopt a dog? *

Does any member of your household suffer from allergies? If so, please explain in detail. *

Which animal are you interested in applying for?

Please type the name of the animal you are interested in applying for. *

What traits are you looking for in a new pet? (ex. puppy, adult, potty trained, male, female, etc.) *

Please describe the pup's living situation (ex. house pet, live in basement/garage, guard dog, live outdoors etc.) *

Will the animal be kept inside or outside? * Choose one: Inside Only Outside Only Inside and Outside

How many hours per day will the animal be home alone? *

Where will the animal be kept when you are not at home? (ex. crate, pup pen, outside kennel, loose indoor or out) *

How will you exercise this pup? (i.e. Leash walks every day, cable or pup run in the yard, free to run in fenced yard, supervised access to unfenced yard, free to roam around off leash and unsupervised in unfenced area, dog-park) *

Where will the animal sleep at night? *

How will the dog be cared for during overnight absences or while on vacation? *

What type of setting is the home in? (rural, suburban, urban) *

In what type of home do you live? * Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

Do you own or rent your home? * Choose one: Own Rent

Have you checked to make sure your home owner's insurance allows you to own a pit bull or pit bull mix type dog? (We will need to see proof that it will be allowed before we can finalize any adoption) * Choose one: Yes No

What is the yard size? (small, medium, large) *

Is your yard fenced? * Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced

What type of fence? * Choose one: Privacy Chain Link Invisible No Fence

What is the height of the fence? *

If you rent, have you received the approval of your landlord to have an animal? * Choose one: Yes No

If you are renting, please provide Landlord's name and phone number for verification: *

If your landlord allows dogs, is there a breed restriction? *

Do you have other DOGS? If so, provide the following information for each pet - BREED, GENDER, AGE, SPAYED/NEUTERED, SHOTS UP TO DATE?: *

If you had other pups in the past, please let us know their current whereabouts and provide details (i.e. still have, died of old age/disease, hit by a car, given away, disappeared/lost, turned into shelter): *

Do you currently own any other animals? If so, please list here: *

Who will be the main caregiver of the dog? *

Why are you looking to adopt from a rescue as opposed to a shelter? *

Will the dog ride in the back of a pick-up truck, tethered or untethered? *

How would you address undesirable behaviors? *

What will you do if the dog gets into trouble by ruining something you value? *

What are your thoughts on training? *

Have you ever taken a dog to training before? *

Are you willing to take a dog to training? If the answer is no, please explain. *

Are you willing to house train a dog? *

What method of house training will you use, if applicable? *

Are you familiar with heartworm disease and, if so, how would you prevent it? *

List the types of behavior problems you consider NOT acceptable: *

What would you do if you could not keep the animal? Please be specific: *

What circumstances, in your opinion, justify re-homing your pet? *

Have you ever given up a pet? If yes, please explain *

At what point would you consider humane euthanasia, should your dog become ill? *

Why are you considering this breed of dog or adopting from this organization? *

Please supply the name and phone number of your current veterinarian, or the one who saw your previous pet(s), with their title identification. If you don't have a vet, please provide the name of your employer, clergyman, or anyone not related to you who can attest to your character. Vet references are preferred. *

List at least one reference (who is not a family member) *

Remembering that pets are an investment of your time and money, can you afford to provide medical care, grooming, proper diet, proper shelter, training, and exercise for your pet: * Choose one: Yes No

Do you have current applications with any other rescues/shelters? If so, please provide that information: *

How did you hear about us? *

Additional information you would like to provide about yourself and/or the pup you would like to adopt: *

I certify that the information entered on this application is true. Enter your name and date: *