ADOPTION APPLICATION Date* Name First Last Please list any previous names such as maiden or legal name changes you have made.*Please enter N/A if this isn't applicable to you. Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Past residence address if less than 2 years at current residence Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email* Secondary Email (if applicable) Alternate Email (if applicable) Home Phone*CellWorkDate of birth (Please list ALL household members)*NameRelationDate of Birth Enter in 00/00/0000 formAre you interested in a particular dog? If so, which one?*If the dog you are interested in is a pit bull/bully breed - why do you want a pit bull/bully breed? How did you hear about us?*Have you ever been convicted of a felony?*NoYesHas anyone who lives at your residence with you been convicted of a felony?*YesNoPlease list three references (not family) with current and complete phone numbers:*NameRelationPhoneAddress Do you have an UNFENCED above ground pool, an in-ground pool, or a lake or retention pond on or near your property without a fence completely surrounding the perimeter? (Keep in mind we will check.)*YesNoWhere do you work? If you're a student indicate where.*If you're not employed, please enter "No employer."Course of study (if applicable):*Please enter N/A if not applicable to you.Your occupation (if applicable):*Please enter N/A if not applicable to you or student, if applicable. Employer's City and StateYour Household Income*under $18,00018,000 - 25,00026,000 - 35,00036,000 - 45,00046,000 - 55,00056,000 - 65,00066,000 - 75,00076,000 - 85,00086,000 - 95,000$96,000 or aboveHousehold income per year please select:Is there a co-applicant for this adoption?*YesNoIf applicable.Your Household ScheduleYour Weekday Schedule: During the week, from the time you leave in the morning to the time you arrive home, how many hours are you away from home on an average day?*1-3 hours4-6 hours7-10 hours10+ hoursResidence Description:*RentOwnLive with family memberLandlord Information (Renters Only)As part of the application review process, I require the consent of your landlord to move forward with your application to adopt. We cannot accept applications from renters if you do not include this information. Landlord Name (Renters only):*Please enter N/A if not applicable. Landlord's Phone Number:Is there a Pet Policy Rental Restriction?*YesNoDoes your landlord allow pets?*YesNoCommunity InformationHave you checked with your local town, village, etc. to make sure there aren't any restrictions on owning a bully breed?*YesNoResidence Type*Apartment or condo (Small building 4 units or less)Apartment or condo (Mid-size building under 50 units)Apartment or condo (Large building 51+ units)Dorm RoomFarmSingle Family HomeTownhomeLength of Residence*Less than 1 year1-2 years3-5 years6 years +How long have you lived here?*What company is your current homeowner or renter insurance with?*Future Residence Plans*Less than 1 year1-2 years3-5 years5+ yearsJust moved inHow long do you intend to stay at this location?*Do you have stairs in your residence?*YesNoPlease check all that apply:*Stairs: several flights between floorsStairs: stairs to enter residenceYes, only a few small stairsOne level with no stairs at allAir conditioning:*Yes - Central AirYes - One window unitYes - Multiple window unitsNo air conditioningDo you have functioning air conditioning?*YesNoWe will be checking on our home visit. Outdoor SpaceFully fenced private yard?*YesNoDo you have a yard?*YesNoElevated balcony or porch?*YesNoTell Us About Your FamilyDo you currently have any pets in your home?*YesNoIf you answered yes to the question above, please list your pets and additional details below.NameAgeType of petBreedUp to date on vaccinations?Is your pet spayed or neutered? How many people (humans, not dogs) in total live in your home including yourself?*Any Children in the Home?*YesNoChoose yes if any household members are under the age of 18. Future Family Plans:*In the next 12 months1 to 2 years2 to 5 years5+ yearsNo PlansUnknownWe need to know about everyone that lives in your household. Please list them by NAME, Date of Birth, and RELATIONSHIP.*NameDOB - Month/Day/YearRelationship (i.e. self, spouse, significant other, son, daughter, parent, etc). We will need to meet with all members of your household during our home visit interview. All in favor of a dog?*YesNoAll willing to help with the daily chores of having a dog?*YesNoAre all members of the household willing to work with the rescued dog on things like house training, socialization, manners, medical and dietary needs, etc.?*YesNoIs anyone in your household allergic to pets?*YesNoDoes anyone smoke inside the home?*YesNoIs your home noisy?*YesNoHome ActivityHow do you describe your household? Keep in mind, we were young once. We are not looking for a perfect answer. We are looking for an honest answer.*ActiveSedateBoisterousChaoticRespectfulCalmOrderlyTrafficHow would you characterize the activity level in your home? Please check all that apply.*Adult visitors: DailyAdult visitors: Once a weekAdult visitors: Once a monthAdult visitors: A few times a yearAdult visitors: No visitorsVisiting children: DailyVisiting children: WeeklyVisiting children: MonthlyVisiting children: A few times a yearVisiting children: NeverWhat is the age range of children who visit your home? Check all that apply.*Newborn (under 6 months)Infant (6 months to 2 years)Toddler (2 years to 4 years)Pre-School (4 years to 6 years)Grade School (6 years to 12 years)TeenagerPlease share your experience with dogs.Are you a first time pet owner?*YesNoDog experience:*Yes - I had dog(s) on my ownYes - It was my parent's dog(s)No - This is the first time.Pit bull experience:*YesNoWhat kind of breeds have you owned?* Other pets:*CatsBirdsReptilesN/ANot listedHave you ever rescued an animal before?*YesNoRescue Organization*Address* City State / Province / Region Have you fostered with or are you currently fostering any animals under another rescue organization?*YesNoRescue Organization*Address* City State / Province / Region Have you ever surrendered an animal before?*YesNoHave you ever had to give a pet (dog, cat, bird, etc.) to a friend, relative, or rescue in the past?*YesNoHave any of your pets ever been lost or stolen?*YesNoOutdoor pets:*YesNoYour Veterinary Clinic Contact InformationVeterinary Clinic Name*We check veterinary references as a mandatory part of the application review process. Please provide the name of your current vet clinic or the name of the clinic you used within the last 3 years if you do not currently have a pet. Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Veterinarian's Name* First Last Phone*What is the name of the Emergency Veterinarian/Clinic that you will use during the hours when your primary vet is closed?*How many miles is this Emergency Vet/Clinic from your house?*Your Pit Bull Care PlanPit bull familiarity:*I have heard a bit from friendsI have researched the breed onlineI have attended local events to meet and learn about bulldogsI have prior experience with the breedNone right now, but I want to learnWhat is your level of familiarity with common bulldog health issues? Depending on breeding history, they are susceptible to allergies. Are you prepared for the expense?*YesNoHow do you plan to exercise your dog? Describe how often and where you will exercise your dog.* Who will be the main caretaker for your dog?*In the event of a separation between you and your spouse, significant other, or roommate, who will keep the dog?*Crating:*I will never use one.I will use one for house training.I will use one when my dog is naughty.I will use them as a "den" or safe place for my bully.How do you feel about the use of crates or kennels?* Living AreaWhat spaces in your house can your adopted dog call his/her home?* Please describe rooms, furniture, other spaces that will be OK and include a description of those spaces where your dog WILL NOT be permitted. Daily Away Time CareDuring the time you (and co-applicant if applicable) are away from your home on any given day, what is your plan to keep your dog safe, as well as your household items safe?* Who will care for your dog while you are on vacation or business trips?* Your Financial ExpectationsFinancial expectations:*I am concerned about the cost of pet ownership as I will need to watch my expenses.I have mild concerns about the expenses of owning a pet but this is not likely to have a significant impact on my budget.I have no concerns about the cost of owning a pet and it will have little or no impact on my budget.Please choose the statement that you most agree with. Adoption Fee ExpectationsHow much do you expect to pay for the adoption?*What do you expect for annual expenses for routine veterinary care (shots, wellness visits, etc.)?*What do you expect to pay for food?*What are your thoughts on spay/neuter?*EmailThis field is for validation purposes and should be left unchanged.