New Hope Pit Bull Rescue

Dog Adoption Application Form

Contact and Personal Information

Please enter your full name::

Street Address:

City:

Zip Code:

Home Phone#

Work Phone#

State or Province:

E-Mail:

Date of birth:

Occupation:

Employer's name/number:

How long have you been employed with this company?

Spouse/partner's full name:

Spouse/partner's employer name/number:

How long has your spouse/partner been employed with this company?

Do you live with:

spouse/partner room mate/s parents alone

Who will be primarily responsible for the financial expenses and daily care of this dog?

Does every individual in your home agree to adopting a pit bull?

Yes No

Do any individuals in your home have allergies to animals/dogs?

Yes No

Names and ages of other household members:

Do any children (under 18) live in or visit the household? If yes, what are their ages?

To Be Considered A Potential Adopter, You Must:

Living Situation and Lifestyle

Dog's living situation

Dog will be house pet, living inside with family Dog will live in basement or garage Dog will live outdoors Doghouse provided Guard Dog for business Guard Dog for residence

Other - please specify:

How many hours a day will dog be home alone?

When home alone dog will be

In a crate, wire cage, or dog pen inside In an outdoor Kennel In an indoor kennel In an outdoor and indoor kennel Tied up outside with a cable run Tied up outside with a chain Dog will be loose indoors Dog will be loose outdoors

Other - please specify:

How will you exercise the dog? (check all that apply)

Leash walks every day

Will have cable or dog run in the yard

Will be free to run in fenced yard

Will have supervised access to unfenced yard

Will be free to roam around (Off leash and unsupervised in unfenced area)

Will bring to dog park (Public area where dogs can run and play together off-leash)

Other:

Other - please specify:

Is the home in an:

urban suburban rural

Yard size is:

small medium large acreage don't have a yard

Is the yard enclosed by a fence?

yes no

If so, height, length, and type of fence:

Do you live in a:

house apartment

Do you own the property?

yes no

If you are renting, please provide Landlord's name and phone number for verification:
**PROOF MUST be provided before adoption: we reserve the right to contact landlord or apartment complex for verification.

Do you live in a rental home/apartment, or in a county/area which enforces breed specific restrictions? (this means that Pit Bulls are NOT allowed in the area and or/home where you live)

yes no

If so, please describe the nature of the restrictions:
 

Other Pets and Experience

Is this your first time owning a Pit Bull?

yes no

Have you ever been convicted of animal cruelty, dog fighting or other crime relating to animals?
If yes, please explain:

Have any of YOUR pets (not strays) been picked up by/taken to animal control?

Yes No

If yes, please tell us why:

Was the animal reclaimed?

Yes No

If not, why?

Do you currently have any other DOGS? Owned and/or fostered. (Check all that apply)

No other dogs

One or more spayed female

One or more neutered male

One or more UN-spayed female

One or more UN-neutered male

Please specify breeds and ages of other dogs:
 

If you had other dogs in the past, where is the dog now?

Please specify what happened:

What other kind of animals do you own?

Why do you want to adopt a Pit Bull?

Experience:
Please relate any prior experience you have had with this breed:

REFERENCES

Who is your past AND/OR current veterinarian?
** If you do not have a veterinarian, Please feel free to ask us for recommendations in your area. Within 30 days of adopting from our organization, a relationship needs to be established with a veterinarian.

What is your veterinarian's phone number?

May we call your veterinarian for a reference?

Yes No

Additional References: Please supply the name and phone numbers of your employer, clergyman or anyone not related to you who can attest to your character. Please provide more than one reference:

Dog(s) you are interested in adopting

Male Female Either

Puppy Adult Either

Already spayed/neutered NOT spayed/neutered No preference

Job change (increased work hours, longer commute time, change of schedule, loss of job/income), career change, or decision to attend/return to college

Living situation changes (move to new home, move in with spouse/partner, obtain roommate(s)

You move to an area/home which does not allow Pit Bulls

Someone in household develops allergies to animals/dogs

You decide to get married, separated, or divorced, or decide to have a baby

Dog escapes from yard

Dog chews on furniture, house, etc. or is destructive when not supervised

Dog has housebreaking/crate training problems

Dog has behavioral problems such as separation anxiety, etc.

Dog does not get along with your current dog(s), cat(s), or other pet(s)- please be advised that even Pit puppies CAN mature to be dog aggressive- you are NEVER guaranteed that a Pit Bull of ANY age will ALWAYS get along with other animals.

Proper vet care is too expensive for you

Dog develops health conditions in the future

Other- Please explain:

Do you know what heart worm disease is and how to prevent it?
**If you do not know we will be more than happy to explain.

Yes No

Is/were your current dog(s)/previous dog(s) on heart worm prevention?

Yes No

Are you aware of the financial responsibility involved in owning a pet (high quality food, treats, toys, annual vaccinations, flea prevention, heart worm prevention, emergency costs, etc.) and are you prepared to take care of this animal for the duration of its life?

Yes No

Additional information you would like to provide about yourself and/or the dog you would like to adopt?

Liability and Responsibility

* 1. By checking YES you agree to absolve New Hope Pit Bull Rescue from any liability in reference to a dog featured in this organization.

Yes No

Yes No

Yes No

Yes No

Yes No

By clicking submit, I certify that the information I have given is true and that I recognize that any misrepresentation of the facts may result in my losing privilege of adopting a pet. I authorize investigation of all statements on this application.

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