RING DOG RESCUE PET ADOPTION APPLICATION PO BOX 28632, RICHMOND, VA 23228 (804) 622-4200 www.ringdogrescue.org NAME:________________________ SSN:___________________ ADDRESS:_____________________________________________ CITY:_________________ STATE:_____ ZIP:________ HOME PHONE#:______________ WORK#:________________ CELL#:__________________ E-MAIL:_______________________ DATE OF BIRTH:__/__/____ EMPLOYER:____________________________________________ WHY IS THIS A GOOD TIME TO ADOPT?_____________________ WHY ARE YOU INTERESTED IN ADOPTING A BULLY BREED? _______________________________________________________ ARE YOU INTERESTED IN A PUPPY___ ADOLESCENT__ ADULT__ WHAT SIZE?__________ WEIGHT?_____________ MALE__ FEMALE__ WHO IS THIS PET FOR? MYSELF__ FAMILY__CHILDREN__ GIFT__ IF A GIFT, FOR WHOM?_____________________________________ MARITAL STATUS: MARRIED__SINGLE__PARTNER__ NUMBER OF ADULTS IN HOUSE HOLD? ___ CHILDREN?___ 1 WHAT ARE THE CHILDRENS AGES?_________________________ IS EVERYONE IN THE HOUSEHOLD AGREEABLE TO ADOPTING A BULLY? _________________________________________________ DO YOU OWN? ___ OR RENT?___ NAME OF LANDLORD:______________ PHONE#:_______________ DOES YOUR LEASE ALLOW PETS?______IS THEIR A WEIGHT OR BREED RESTICTION (BE SPECIFIC)?________________________ DO YOU KNOW THAT CERTAIN HOMEOWNERS INSURANCE COMPANIES WILL NOT CARRY A BULLY HOME?___________ DO YOU NEED INFO ON WHO DOES AND DOES NOT? Y__N__ DO YOU HAVE A FENCED IN YARD?______________________ WHAT TYPE OF FENCE?____________HOW TALL?__________ WHERE WILL YOU KEEP YOUR BULLY WHEN YOU ARE NOT HOME? _____________________________________________________ DO YOU HAVE A CRATE? Y__N__ DO YOU KNOW THE BENEFITS OF CRATE TRAINING?________ DO YOU NEED INFO AND INSTRUCTION ON THIS?____________ HOW MANY HOURS A DAY WILL YOUR BULLY BE LEFT ALONE? (BE SPECIFIC) _________________________________________ WHAT OTHER PETS DO YOU OWN? NAME- BREED- MALE/FEMALE-SPAYED/NEUTERED--AGE 1______________________________________________________ 2______________________________________________________ 3______________________________________________________ 4______________________________________________________ 2 WHO IS YOUR VETERINARIAN? NAME:______________________ PHONE #___________________ ARE ALL OF YOUR PETS CURRENT ON VACCINATIONS AND RABIES? YES______ NO______ IF NOT WHY?________________________ WHO WILL WATCH YOUR PET WHEN YOU ARE OUT OF TOWN OR AWAY FOR THE NIGHT?___________________________________ WHAT WOULD HAPPEN TO YOUR PET IF YOU HAD TO MOVE? ________________________________________________________ DOES ANYONE IN YOUR HOUSEHOLD HAVE ASTHMA OR ALLERGIES? Y____ N_____ DID YOU HAVE PETS BEFORE THAT ARE NO LONGER WITH YOU? Y______ N______ WHAT HAPPENED TO THOSE PETS?_________ ________________________________________________________ HAVE YOU EVER SURRENDERED AN ANIMAL TO A SHELTER OR RESCUE?_______________________________________________ TYPE OF ANIMAL: ______________ SHELTER:_________________ REASON FOR SURRENDER:________________________________ HAVE YOU EVER BEEN REPORTED TO ANIMAL CONTROL, OR HAD AN ANIMAL REMOVED FROM YOUR CARE? Y__ N__ IF YES, WHAT HAPPENED? (PLEASE EXPLAIN THE CIRCUMSTANCES AND OUTCOME) __________________________________________ _________________________________________________________ WHAT BEHAVIORS DO YOU FIND UNACCEPTABLE IN A PET? _____ _________________________________________________________ WHAT DO YOU ESTIMATE YOU WILL SPEND ON THIS ANIMAL IN ONE YEAR? ______________________________________________ 3 REFERENCES (PLEASE LIST THREE PEOPLE OUTSIDE OF YOUR HOME) NAME PHONE NUMBER RELATIONSHIP TO YOU 1________________________________________________________ 2________________________________________________________ 3________________________________________________________ BY SIGNING BELOW, I CERTIFY THAT ALL THE ABOVE INFORMATION IS TRUE, AND I RECOGNIZE THAT ANY MISREPRESENTATION OF FACTS MAY RESULT IN LOSS OF MY ADOPTION PRIVILEGES. I CERTIFY THAT I HAVE NEVER BEEN CONVICTED OF ANIMAL CRUELTY, NEGLECT, ABUSE, OR ABANDONMENT. I AUTHORIZE VERIFICATION OF ALL STATEMENTS IN THIS APPLICATION WITH LISTED VETERINARIAN, REFERENCES AND LANDLORD. RING DOG RESCUE RESERVES THE RIGHT TO REFUSE ADOPTION TO ANYONE, WHO IN ITS OPINION, WILL NOT PROVIDE A SUITABLE HOME FOR THIS PET. SIGNATURE:_________________ DATE:________________ DRIVERS LICENSE #:____________________________ INTERVIEWED BY: ______________________________ RDR ANIMAL ID #:__________________________ PETS NAME:______________________________ OUTCOME:_______________________________ RECOMMENDATIONS:__________________________________ _____________________________________________________ _____________________________________________________ 4