ANIMAL FARM FOUNDATION, INC

Animal Farm Foundation, Inc.

A not-for-profit corporation

Website: http://www.animalfarmfoundation.org/ Phone: (518)-398-0017

Email: info@animalfarmfoundation.org Fax: (518)-398-0737

Address:

Animal Farm Foundation, Inc.

P.O. Box 624

Bangall, NY 12506

Adoption Application

(Please fax or mail back for review)

How did you hear about our dogs?

____________________________________

RESIDENTIAL INFORMATION

Name: __________________________________________________________________

Address: _______________________________________________________________

City: ___________________________________________State: ___________

Zip Code: ___________

Daytime Phone: (___)________________

Evening Phone: (___)_______________ Fax: (___)____________

E-Mail Address: ________________________________________________________

Date of Birth for Potential Adopter: ________________

Length of Residency: _____________ Home or Apt: __________________

Own or Rent: _____________

If renting, does landlord allow dogs? YES NO

If renting, landlord name, address and phone number:

________________________________________________________________________

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

________________________________________________________________________

PERSONAL INFORMATION

Are you employed? YES NO

Length of employment: _______Occupation: ____________________

Name of Employer: ____________________________________________________________________

Address of Employer: __________________________________________________________________

Business Phone: (____)_____________

What are your work hours? _______________________________

What are other household members work hours?_____________

Household: # of Adults ____________

# of Children/Ages: __________________

Do you or any members of your family have allergies to animals?

YES NO

Do you travel for business or vacation? YES NO

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

If you share a dwelling, are other members in agreement concerning the adoption of an animal? YES NO

Are you familiar with your local dog ordinance? YES NO

Are there any restrictions or limitations to “Pit Bull” ownership in your community? YES NO

Have you considered the daily expenses for maintaining an animal

(food, medical, grooming, obedience classes, etc.) ?

________________________________________________________________________

Information about You and Your Pets

Current Pets (Please complete the following information for all dogs living in your home):

Dog(s) – Breed/Sex/Age/Disposition/Length of ownership/Place of origin

________________________________________________________________________

Cat(s): ________________________________________________________________

Other: _________________________________________________________________

Are your current pets:

spayed/neutered? YES NO

vaccinated? YES NO

on flea/tick preventative? YES NO

on heartworm preventative? YES NO

Previous pets:

Dog(s)-Breed:___________________________________________________________

What happened to previously owned dogs?

________________________________________________________________________

What did you like and dislike about your previously owned dogs?___________________________________________________________________

________________________________________________________________________

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:

1.______________________________________________________________________

________________________________________________________________________

2.______________________________________________________________________

________________________________________________________________________

3.______________________________________________________________________

________________________________________________________________________

Your Pet’s New Home

Do you understand that a “pit bull” will need substantial, regular exercise? YES NO

How will you be providing this exercise?________________________________

________________________________________________________________________

Where will the dog spend its day?

________________________________________________________________________

Where will this dog spend its night?

________________________________________________________________________

Fenced Yard YES NO

Type of Fence_________________

Fence Height (in Feet) ________________

Approx. Size of Fenced Area ________________

Fenced Kennel Area? YES NO

Would You Consider A Fence Or Kennel Area? YES NO

Do you intend to crate this dog? YES NO

For how many hours? __________________

Are you familiar with humane procedures for housebreaking a pet?

YES NO

Do you realize that “pit bulls” are people loving dogs and will need considerable time and attention? YES NO

How do will meet these needs?___________________________________________

________________________________________________________________________

Are you familiar with the characteristics and temperament of the American Staffordshire Terrier/American Pit Bull Terrier? From hands on experience? From websites? From books? Please describe:______________

________________________________________________________________________

Why did you choose this breed, and what are the qualities you like in this breed? What challenges do you feel this breed may present?________

________________________________________________________________________

Selecting Your New “Pit Bull” Friend

Did you see “pit bulls” on our website which interests you? Please name?___________________________________________________________________

________________________________________________________________________

General Preferences:

Male/Female Age ___________________ Color __________________

Can you bring all family members and pets to meet the dog you are considering? YES NO

Will you enroll in obedience class within 4 weeks of adoption? YES NO

Do you want continue obedience work with your partner as needed? YES NO

May we visit your home as part of the pre-adoption process?

YES NO

Will you agree to license and provide total health care for this dog?

YES NO

Will you agree to keep rabies vaccination current? YES NO

Will you return a dog if you cannot keep it? YES NO

Will you continue heartworm preventative? YES NO

Often times the complete history of a rescue 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:_______________________________________________________________

________________________________________________________________________

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, Inc. will be spayed/neutered, up to date on all shots, and micro-chipped.

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Signature of Potential Adopter

Thank you for taking the time to complete this application. It assists us in recommending pet adoption options for you.

We will contact you within 24 hours.