Adoption Application

If you wish to download a copy of this application you can download the form here: Adoption Application (Microsoft Word format)

Adoption Application

• Name of Primary Adopter *

• Email Address (optional):

• Birth Date *

• Address: *

• City *

• State *

• Zip Code *

• County *

• Length of Time at this Address *

• Occupation *

• Day Phone *

• Cell Phone

• Evening Phone *

• What dog are interested in?

• 1st Choice *

• 2nd Choice

• What kind of temperament are you looking for? *

• Is there a particular color of dog your prefer?

• Age preference?

• Why do you want a Bully breed? *

• References

• Vet Name *

• Vet Phone *

• Vet records are under the name of *

• Name #1 *

• Phone #1 *

• Relationship #1 *

• Name #2 *

• Phone #2 *

• Relationship #2 *

• Please list place of employment for yourself and your spouse, if applicable:

• Your Employer:

• Length of service:

• Address:

• Phone:

• Spouse’s Employer:

• Length of service:

• Address:

• Phone:

• Household Information

• Home (Select One): *

  Own   Rent

• Type of house (Select One):  *

  single family   townhouse   condo   apartment

• Are you moving in the near future? (Select One) *

  yes   no

• If so, please explain:

• If you own your home,

• Insurance Company:

• Phone:

• if you rent your home,

• Landlord Name:

• Phone:

• In addition to yourself, list below all people who currently live at this residence.

• Name:

• Age:

• Relationship:

• Name:

• Age:

• Relationship:

• Does anyone in your house have any allergies to dogs? *

  yes   no

• List below any cats, dogs, or other animals who currently live in your household: (If applicable)

• Name:

• Breed:

• Age:

• Gender:

• Spayed or Neutered?

  yes   no

• Owned how long:

• Kept where:

• History

• Have you owned a dog before? (Select One) *

  yes   no

• A large breed?  *

  yes   no

• A large Bully breed – American Pit Bull Terrier or Staffordshire Terrier? *

  yes   no

• If yes, please explain in detail what happened to it:

• If your last dog died, please state the dog’s name and date deceased:

• Have you ever taken one of your pets to a shelter?  *

  yes   no

• If yes, please describe the circumstances:

• Fences

• Do you have a fenced area on your property?  *

  yes   no

• What type of fencing do you have?

  privacy   split rail   metal   wood   other

• Is the area completely fenced?

  yes   no

• How high is the fence? (In Feet)

• Does the fence have a lockable gate?

  yes   no

• Approximately how many square feet of space is fenced area (length x width):

• Exercise

• If you don’t have a fence, how do you plan to have your dog relieve/exercise itself?

• Do you realize even with a fence that dogs need to be leash-walked every day?

  yes   no

• How active is your lifestyle aside from work? Please explain: *

• Do all adults work full time?  *

  yes   no

• If no, please explain:

• How many hours each day will your new dog be alone?  *

• How many hours each day will you spend time with your new dog?  *

• Where will your new dog be kept when it is alone?  *

• Where will your new dog sleep?  *

• We strongly advise using a crate with your new dog – do you agree?  *

  yes   no

• If no, please explain:

• Condition:

  As a condition of adoption, BTCPBR expects dogs and their owners to attend an obedience training class within 90 days of adoption. This helps bond the dog with its new owner, establishes the owner’s leadership role and provides a fun learning experience for both of you.

• Would you be able to do this?  *

  yes   no

• If no, please explain:

• Are you agreeable to having a home check done prior to adoption? *

  yes   no

• If no, please explain:

• If you are ever unable to keep the dog, we require the dog be returned to us. Is this agreeable?  *

  yes   no

• Donation

  BTCPBR requests a donation when adopting a dog. Depending on the expenses incurred in the dog/puppy’s rescue and veterinary care, this could range up to $300.00. All animals are spayed or neutered prior to placement.

• Is this acceptable?  *

  yes   no

• Important Note:

  Please realize that dogs need regular veterinary care throughout their lives, including yearly vaccination boosters, monthly heartworm pills as well as flea and tick preventative medications. Bully breeds typically live for 10-12 years.

• If you find the donation for our dogs expensive, you need to evaluate how you can reasonably expect to afford the appropriate veterinary care each dog requires. Please seriously consider these costs before adopting.

• BTCPBR volunteers work extremely hard to ensure our dogs are healthy and up-to-date on vaccinations. We want our dogs to continue to receive regular medical check-ups to maintain their health. It is YOUR responsibility to pay for any medical costs your dog requires.

• Are you prepared to accept this responsibility?  *

  yes   no

• If yes, then please indicate by signing below.

• I confirm all information contained herein is true and accurate to the best of my knowledge and agree to conform to the aforementioned requirements of care.

• Signature:

• Date:

• If completed via email or the website you can sign this document when you meet the dog.

• Supporting breeders is not what we need to do when there are so many homeless bully breeds in the U.S. We need to find loving, responsible homes for the many dogs that are already here and dying in shelters every day.

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