Pits and Rotts for Life Rescue Inc.

Adoption Application - Please note that filling out this application does not guarantee that you will be approved for
adoption, nor does it require you to adopt a dog from our organization. All of our dogs come to you spayed/neutered, up
to date on veterinarian recommended vaccines, microchipped, heartworm/lymes tested, on heartworm/flea/tick
preventative and dewormed.   All of our dogs have been temperment tested.   There is an adoption donation required
(between $250-$350).
Name: First, Middle and Last (please include maiden name/s)
Home Phone
Your complete mailing address.
Cell Phone
Work Phone
How many hours a week do you work?
Email Address:
Name of Significant Other: First, Middle and Last
Significant Other's Age/Birthdate
Names and ages of all children living with you. If they are older then 18, we need first, middle and last name:
Who, beside immediate family and/or children, reside with you? Please name them (full,middle,last), list their relationship and ages:
Are you seeking other avenues to attain a Dog such as other Rescues or Facilities? Yes
If so, please list the other organization's name and phone number.
Is there a certain Dog you are interested in? Yes
If yes, who?
If yes, and he/she is no longer available, would you be interested in another? Yes
If the dog you are interested in is being fostered in another state, are you willing to drive to that state to meet the dog yes
If yes, how far are you willing to drive? (foster homes may meet you in the middle) up to one hour
2-4 hours
4-6 hours
Distance doesn't matter

Would a male or female fit better in your home? Male
Age range? Select all that apply. Puppy (8 weeks-6 months)
Young (6 months-3 years)
Adult (4 years-7 years)
Senior (8 and older)

Any other criteria for dog you'd like to adopt?
Do you rent or own? If you own, your name must appear on the Deed Rent
If you rent, please provide the name and phone number of your landlord.
How long have you lived at this address?
If less than two years, please list your previous address and landlord.
Type of dwelling you live in now? House

Do you have a homeowners or renters insurance policy? Yes
If so, what is the name of insurance company?
Have you checked with your insurance company to make sure they do not have a Breed ban against Pit Bull’s or Rottweilers? Yes
If your insurance company does not allow Pitbulls or Rottweilers, and that is what you are applying for, are you willing to change your insurance company to one that does? Yes
Not applying for that breed
Do you have a fenced yard? Yes
If yes, how large is the fenced area?
If yes, what kind? Chain Link
If yes, do you currently keep the gate padlocked? Yes
If yes, how tall is the fence?
If yes, is it secured underground as well? Yes
If no fence, do you plan on putting one up? Yes
Do you have a kennel area? Yes
If you do not have an outside kennel or fenced yard, please explain how you will allow for the dog to defecate/urinate and be exercised?
Do you have a pool? Yes
If yes, is it fenced separately?
Will the Dog be kept indoors or outdoors? Indoors
Please describe where and how the dog will live, on a typical day. Please be detailed.
Is someone home during the day? Yes
If not, where will the dog stay while you are gone?
How many hours per day will the dog be left alone and/or crated?
Do you have a crate? Yes
No, but will purchase one if necessary.
No, and will not purchase or use one.
If you have a crate or you are going to purchase one, what kind of crate will be used?
Have you ever owned a Rottweiler or Pit Bull? Yes, a Pit Bull
Yes, a Rottweiler
Yes, both
If so, which Trainer was used to train him/her?
If you have previously adopted any a Dog, who did you adopt from?
Do you currently have any other pets? Yes
If yes, please describe the pets in detail and give names ages and breeds of all pets.
Please list any and all Animal’s you have owned in the past 10 years; please give names, ages, breed and what has happened to them if they are no longer with you.
If you have a current pet, is he/she an only pet? Yes
If yes, for how long?
If you own or have owned a dog, were they or are they spayed or neutered and current on vaccinations? Yes
If no, please explain why.
Are your Dog’s or were any previous Dog’s on heartworm preventative? Yes
Not Sure
If yes, what type?
If no, please explain why.
Approximate date of your current pet's last office visit?
Have you ever given any of your Pets away or surrendered them to anyone? Yes
If yes, please give the name and phone number of the person to whom you surrendered the Pet and please explain why you gave the Pet away.
Do you belong to any Kennel Clubs, Obedience Clubs, or other dog-related clubs? Yes
If yes, please list and describe.
Do you know the city animal ordinances/licensing procedures in your area? Yes
Do you have a city or county ordinance that limits the number of dogs you are allowed to have in your home? Yes
Not sure
If yes, how many are you allowed to have?
Please explain why you wish to adopt this breed.
What steps have you taken to learn about this breed and/or dog ownership?
We will attempt to provide you with an honest evaluation of temperament on any dog we adopt to you, do you realize that often times the complete history of any dog may not be known and you may encounter some behavioral problems? Yes
Are you willing to work with us on correcting these problems? Yes
Are you willing to take the adopted dog to obedience classes? Yes
Why or why not?
What behavioral/training issues ‘can’ you deal with?
What behavioral/training issues can you ‘not’ deal with?
If you were to return this (or any) dog, for what reason would it be?
What length of time do you feel is adequate to allow an adopted Dog to adjust to your home?
What length of time are you willing to give a Dog to adjust to your home?
How did you hear about Pits And Rotts For Life Rescue Inc.?
Please list your Veterinarian’s name address and phone number, if you have recently changed Vet’s and it is less than one year; please also list the name and number of your previous Veterinarian.
Please list the names, addresses and phone numbers of three references, other than relatives or people that live with you. You must provide these or we will NOT be able to proceed with your application. Thank you 1.
Reference 2
Reference 3
I agree that the above answered questions are true and understand that they will be verified. I understand that by submitting this application to Pits and Rotts for Life Inc. it is not a guarantee of adopting a dog. I agree that a visit to my home prior to adoption is welcomed. I authorize Pits and Rotts for Life Rescue Inc. to use any sources above to verify or request any information. Please initial here.
My full name typed in this space acknowledges that this is legal and binding and that if an adoption is finalized, Pits and Rotts for Life Rescue will again take possession of the adopted dog if he/she is not being cared for properly and/or abused. I agree to sign a full adoption agreement upon my application and homevisit being approved. Print entire name here.

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