Riley Rescue Adoption Application

Please list the dog(s) you’re interested in adopting:

How soon are you looking to adopt?*

ImmediatelyOne weekTwo Weeks or more

All of our dogs are located in foster homes. It is expected that you will travel to the foster’s location in order to meet/adopt. Please mark the maximum distance you are willing to travel to adopt.*

Under 30 minutesAn hour or lessLess than 2 hours2 hours or more

Full Name*

First NameLast Name

Age*

Occupation*

Spouse’s Full Name

First NameLast Name

Spouse’s Age

Occupation

Best E-mail to contact you:*

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Phone Number - Home

Area CodePhone Number

Phone Number - Cell

Area CodePhone Number

First Reference*

First NameLast Name

Phone Number*

Area CodePhone Number

Second Reference*

First NameLast Name

Phone Number*

Area CodePhone Number

Third Reference*

First NameLast Name

Phone Number*

Area CodePhone Number

Do you live in a:*

Do you:*

OwnRentLive with ParentsOther

If renting or living with parents: Please indicate landlord’s or parent’s name and phone number.

Please List all People Living in the Household (Include Name, Relationship, and Age)*

If you have children, please list their previous experience with dogs:*

Are all members of your Family agreeable to adopting a dog?*

YesNo

Does anyone in your household have allergies to animals?

YesNo

Do you currently have pets?*

YesNo

Pet 1: Name:   Name* is a   type (Dog / Cat).*   Age:    Age*
Spayed/Nuetered    *
How long have you owned above pet?   Years*.

Pet 2: Name:   Name is a   type (Dog / Cat).   Age:    Age
Spayed/Nuetered
How long have you owned above pet?   Years.

Pet 3: Name:   Name is a   type (Dog / Cat).   Age:    Age
Spayed/Nuetered
How long have you owned above pet?   Years.

Pet 4: Name:   Name is a   type (Dog / Cat).   Age:    Age
Spayed/Nuetered
How long have you owned above pet?   Years.

Pet 5: Name:   Name is a   type (Dog / Cat).   Age:    Age
Spayed/Nuetered
How long have you owned above pet?   Years.

Would you be willing to have a Riley Rescue Volunteer call your veterinarian for a reference check? (Please authorize vet to speak with us)

YesNo

Veterinarian Name*

Phone Number*

Area CodePhone Number

Do your pets get along with other animals?*

YesNo

Have you ever had to surrender or give away a pet?*

YesNo

If yes, please explain.*

How many hours will your dog be left alone?

Do you plan to crate train?

YesNo

Where will your new dog sleep at night?

Do you have a fenced yard?*

YesNoPartial

How will you be exercising your pet?

We cannot guarantee a dog to be housebroken, are you equipped to train with patience?

YesNo

How do you plan to house train your new pet?

How will handle obedience training?

Will you seek the help of a trainer if needed?

YesNo

How will you discipline your dog, when he or she misbehaves?

Often a rescued animal has experienced some sort of trauma and as a result may have behavioral issues. Do you feel you are able to handle behavioral issues such as separation anxiety?

YesNo

If Yes please explain

What if any behavioral issues have your dealt with in the past?

If your dog escaped what steps would you take to find him/her?

If you have to move what will you do with your dog?

What reasons would prompt you to rehome your dog?

Pets are an investment of your time and money. Can you afford to provide the necessary medical care, grooming, proper diet, shelter and exercise for your new pet?

YesNo

Are you able to make a long term commitment to care for your pet for its entire life span?

YesNo

If the dog/puppy I am applying for is no longer available please process my application so that I can be preapproved for a future available dog/puppy.

YesNo

Please read and acknowledge each statement:

Riley Rescue reserves the right to refuse adoption to any applicant for any reason.The adoption fee is $560.00. If you have any questions regarding the adoption fee please ask when submitting this application. Adoption fees can be paid via cash or Venmo at the time of adoption. We do not accept checks.I understand that the adoption fee is non-refundable.I understand that the dog/puppy I am adopting is a rescue. Since rescue dogs come from unknown backgrounds any mention of breed, age, or size is just an educated guess based on the overall characteristics of the dog, or information provided at the time of surrender by the previous owner. For this reason most dogs will be referred to as mixed breed. It is possible that the puppy will grow up to be smaller or larger than estimated.I understand that even if I am approved to adopt, this does not guarantee the availability of any dog. All animals are available for adoption until an adoption is completed. I will keep in mind when scheduling appointments to meet/adopt that the animal is not on “hold” and therefore could be adopted by another party until such time as my adoption is completed.

Your name*

Co-Applicant name (if applicable)

Signature

Clear

Riley Rescue Adoption Application

Applicant Information

References

Household Information

Pets

Preparing for your new pet