Dog Adoption Application – Rottie Empire Rescue

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Instructions Please fill in ALL questions to the best of your ability, regardless of whether or not the question is marked mandatory. For questions, please contact us at rottieempirerescue@gmail.com You MUST fill in the appropriate adoption application in order to adopt a pet from Rottie Empire Rescue.

Adopter Information

Primary Adopter's Name *The first and last name of the primary adopter

Secondary Adopter's Name The first and last name of the secondary adopter (if any)

Contact Email address *Please list the best email address for us to contact you at.

Phone Number *Please provide a phone number for Rottie Empire Rescue to contact you with.

Phone Call Times *

Please list the best times for Rottie Empire Rescue to call your phone at. If you have a work phone number, please also list that with the times when we are able to call at that number.

Age of Primary Adopter *Please list the age of the primary adopter

Age of Secondary Adopter Please list the age of the second adopter (if any)

Number of Children *Please list the number of children in your home. List "0" if none.

Children's Ages

Please list the ages of the children in your home, (if any listed above). Please also list if they have previous experience with pets.

Residence Information

Residence Address *

Please give the address where you and your pet will be living.Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Length of Residence *How long have you lived at your current address?

Rent/Own *

Do you rent or own your current residence?RentOwn

Home Type *What kind of home do you live in? Ex: Apartment, House, Townhouse, condominium, etc.

Insurance Check *

Have you checked with your homeowners insurance to make sure that you are able to own the breed of dog you are looking to adopt?Yes, and I can own this breed of dog.Yes, and I cannot own this breed of dog.No, I have not checked my insuranceI do not have homeowner's insurance

Landlord Name Please give your Landlord's name (if any)

Landlord Phone Please give a phone number for your landlord (if you have one)

Yard *

Does your residence have a fenced-in yard?YesNo

Pet Experience

Animal Experience *

Do you have experience with pets or animals? If so, please explain the context, the duration, and whether or not you owned the animal.

Primary Owner *

Have you been the primary owner of a pet before?YesNo

Owner History *

Beginning with a list of your currently owned pets, please list all of the pets you have owned in the last ten years and where they are now. Please include species, breed, and the age of the animal when you first owned it.

Trainer? *

Do your current pets have a trainer?YesNoNo current pets

Lifestyle

Daytime *

Where do you anticipate letting your pet stay during the day?

Nighttime *

Where will your pet stay during the night time?

Vacation Care *

Where will your pet stay if you travel?

Why adopt *

Why do you wish to adopt a pet?

Family Agreement *

Is your family in agreement about adopting a pet?YesNoUnsure

Guard Dog

Would you use your pet dog as a guard dog?YesNoUnsure

Activities *

What activities would you do with your pet?

Surrender *

Why would you give up a pet?

Particular Pet *Is there a particular pet you are interested in adopting?

References

Name of Reference 1 *Please list the name of Reference 1

Ref 1 Phone *Please list a phone number for your first Reference

Ref 1 Email *Please give an email address for Reference 1

Ref 1 Address *

Please give a mailing address for your first referenceStreet AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Ref 1 Relationship *How do you know your first reference?

Name of Reference 2 *Please give the name of your second reference.

Ref 2 Phone Please provide a phone number for your second reference

Ref 2 Email *Please give an email address for your second reference

Ref 2 Address *

Please provide a mailing address for your second reference.Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Ref 2 Relationship *How do you know your second reference?

Acknowledgment *
I understand that my electronically-generated signature is valid as a means of a legal signature for the purpose of this adoption application. I also understand that by typing my name in the field below, I also acknowledge that I have reviewed my answers given in this form and state that all of the information given is true and accurate.I acknowledge and agree
Electronic signature *Please type your name.

Verification

Please enter any two digits *Example: 12
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