Recycled Rotts Placement Application
Name
First Name
Last Name
Age
Email
example@example.com
Name
First Name
Last Name
Age
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number (Home)
-
Area Code
Phone Number
Phone Number (Cell)
-
Area Code
Phone Number
Best Time To Call - include Time and Day
Day
Time
Your Employer
Your Employer Phone
-
Area Code
Phone Number
Spouses Employer
Spouses Employer Phone:
-
Area Code
Phone Number
Number of Children and Their Ages:
How Long Have You Lived At This Address?
If Less Than Two Years - Your Previous Address:
Do You Rent? Name and Phone Number of Landlord
Besides Your Immediate Family, Are Their Others Residing In Your Home?
Yes
No
If Yes, Please List Their Names and Ages
Is Someone Home During The Day?
Yes
No
Does Your Home Have A Yard?
Yes
No
Do You Have A Fence? How Tall? Will The Gate Be Locked?
Where Will Your Dog Be Kept Most Of The Time?
House
Outside
Basement
Other
If Other, Please Explain
Will You Take Your Dog To Obedience Class?
Yes
No
Have You Ever Had A Rottweiler
Yes
No
If Yes, Tell Us About Your Rott
Do You Prefer: Male, Female or No Preference
Male
Female
No Preference
Is There A Dog On Our Web Page or Facebook Page You Are Interested In?
Name Of Dog
Why Do You Want A Rottweiler:
What Activities Do You Plan To Do With Your Rottweiler?
Do You Have Other Pets?
Yes
No
Please List Other Pets And Their Ages
Are Your Current Pets Spayed or Neutered?
Yes
No
Are Your Pets Current on Vaccinations?
Yes
No
Are Your Current Pets On Heartworm Preventative?
Yes
No
Please Provide Your Veterinarian's Name & Phone Number (Please let your vet know we might be contacting them and to release your information)
Please Provide The Name, Address And Phone Number Of Three References:
How Did You Hear About Recycled Rotts?
We will attempt to provide you with an honest evaluation of temperament on any dog we have to place. Do you realize that often times the complete history of a dog may not be known and you may encounter some behavioral problems?
Yes
No
Are you willing to work with us on correcting any possible behavioral problems?
Yes
No
I certify that the information provided on this form is true and correct. I am also financially and physically able to care for this animal. I understand that proper food and veterinarian care can be costly and I am able to meet these requirements. Home checks are made on a random basis prior, or following, a placement. If upon inspection we find that information contained in this application to be false, we retain the right to turn down or remove the animal from your premises without a refund of moneys paid. Signature and Date
Submit
Should be Empty: