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General Information

How did you hear about our dogs?

Personal Information

Name

Address

City  State

Zip Code

Daytime Phone

Evening Phone

Fax

Email Address

Date of Birth for Potential Adopter(s)

Residence Information

Residence House   Apartment

Type Own   Rent

Length of Residency

If renting, landlord’s name, address and phone number:

Please describe your neighborhood. Is your home in a city, town, country, or suburbs?

Employment Information

Are you employed? Yes   No

Length of Employment

Occupation

What are your work hours?

Household Information

What are other household members’ work hours?

How many hours a day will your dog spend alone?

Number of Adults/Ages in household?

Number of Children/Ages in household?

Are you or any members of your household allergic to animals? Yes   No

If yes, please describe:

Do you travel for business or vacation? Yes   No

If yes, who will provide for your animal(s) while you are away?

Community Information

Does your community have a leash-law? Yes   No   Don’t Know

Does your community have breed-specific laws? Yes   No   Don’t Know

If yes, please describe:

Are you prepared to deal with the discrimination that may come with Pit Bull ownership: homeowner’s insurance discrimination; rental restrictions; community bias? Yes   No

Have you considered the daily expenses for maintaining an animal (food, vaccinations, monthly heartworm preventative, monthly flea/tick preventative, unexpected medical expenses, grooming, obedience classes, etc.)? Yes   No

Selecting Your New Pit Bull Friend

Are you applying for a specific dog? Please name:

Preferred Gender Male   Female

Preferred Age

Preferred Color

Can you bring all family members and pets to meet the dog you are considering? Yes   No

Caring for Your New Pit Bull Friend

Will you enroll in obedience class within 4 weeks of adoption? Yes   No

If no, why not?

Are you interested in more advanced training for your dog? Yes   No

May we visit your home as part of the pre-adoption process? Yes   No

Do you agree to license and provide total health care for this dog? Yes   No

Do you agree to keep rabies vaccination current? Yes   No

Will you continue heartworm preventative? Yes   No

What will you do if you cannot keep a dog?

Information About Your Current Pets

Dog(s) Breed

Dog(s) Sex

Dog(s) Age

Dog(s) Disposition

Dog(s) Length of Ownership

Dog(s) Place of Origin

Cat(s)

Other

Are your current pets spayed/neutered? Yes   No

Information About Your Previous Pets

Dog(s) Breed

What happened to previously owned dogs?

References

Name of Veterinarian

Phone

List the Names, Addresses and Phone Numbers of three references we may call who can attest to your suitability as an adopter. For example, an animal professional (behaviorist, trainer, vet, groom, educator), a friend who has a dog, your employer, or a coworker: Reference 1 Reference 2 Reference 3

Exercise, Care & Attention

Do you understand that a Pit Bull will need substantial, daily exercise? Yes   No

How will you be providing this exercise?

Where will the dog spend its day?

Where will this dog spend its night?

Do you have a fenced yard? Yes   No

Type of Fence?

Fence Height (in Feet)

Approx. Size of Fenced Area?

If your yard is not fenced, would you consider installing a fence? Yes   No

Do you intend to crate this dog? Yes   No

If so, When, Why and for How much time?

Are you familiar with humane procedures for housetraining a pet? Please Describe:

Do you realize that Pit Bulls are people loving dogs and will need considerable time and attention? Yes   No

How will you meet these needs?

Breed Information

Are you familiar with the characteristics and temperament of the American Staffordshire Terrier/American Pit Bull Terrier? Please describe:

Of all the breeds available, why did you choose a Pit Bull, and what are the qualities you like in Pit Bulls? What challenges do you feel owning a Pit Bull may present?

Often times the complete history of a rescued dog may not be known. We will provide you with a description of our experience with a dog you are considering; however, do you realize that you may encounter some behavioral problems? Yes   No

Are you willing to work with a professional behaviorist/trainer on correcting problems, should they arise? Yes   No

Additional Comments:

Thank You

We encourage adopters to consider their own needs, preferences, and capabilities before adopting any dog. We welcome you to spend as much time as you need visiting us and our wonderful “pit bulls”. They enjoy meeting new friends. All Pit Bulls adopted from Animal Farm Foundation will be spayed/neutered, up to date on all shots, micro-chipped, and have basic obedience training.

Signature of Potential Adopter (Please type your full name)