Bruised Not Broken Animal Rescue

Are you at least 21 years or older?*

YesNo

Date of Birth:*

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

How long have you lived at listed address?*

What type of housing do you live in?*

Do you Rent, Own, or Lease?*

If renting or leasing do you have approval from the landlord, if so please email written and signed consent to bruisednotbrokenanimalrescue@gmail.com

If you live in an apartment, please add apartment name and phone number.

Are there any children living in the home? If so please list how many and what their ages are?*

Is anyone including people who may want to come visit allergic to animals?*

What brand of food do you currently use? What brand of food do you plan to use for this dog? Wet and or Dry?*

Occupation*

Employer Name*

Employer Phone Number*

Area CodePhone Number

Co-Adopter's Occupation

Employer Name

Employer Phone Number

Area CodePhone Number

Which dog are you interested in?*

Why do you want a dog and why did this dog stand out to you?*

Where will the dog be during the day and the night?*

Have you owned any animals within the last 10 years?*

YesNoN/A

If yes, What has happened to these pets?*

What animals do you currently own? Please list species, breed, age, spayed or neutered, utd on vaccines.*

Please provide your veterinarian's name and phone number:*

Do you have a yard?*

YesNonot applicable

Do you have a COMPLETELY fenced in yard? (No holes, gaps, spaces, missing areas)*

Yes, Our fence is completely safe to bring a new pup home.No, Our fence is not set up for a new pupNo, We do not have a fence.

Have you ever surrendered or re-homed a pet?*

YesNo

If yes, Why?

How would you handle behavioral issues such as excessive barking, anxiety, bathroom accidents, etc?*

What behaviors would be a deal breaker for you and your family?*

What items or things do you think are needed to provide a healthy and safe home for a dog?*

Are you financially prepared to provide the necessary care for your pet including food, vet care, potential medical emergencies *

If you need to leave for an emergency, travel for work or trips, Do you have a plan for the dog? Who will take care of the dog while you are away?*

Please list 3 References (Non-Personal)*

Ref. #1

First NameLast Name

Phone Number

Area CodePhone Number

Email

example@example.com

Ref. #2

First NameLast Name

Phone Number

Area CodePhone Number

Email

example@example.com

Ref. #3

First NameLast Name

Phone Number

Area CodePhone Number

Email

example@example.com

APPLICATION TERMS & CONDITIONS:

* Applicants must be at least 21 years of age *

This application is a step in the process of acquiring an animal from Bruised Not Broken Animal Rescue, but it does not guarantee you will be approved for the dog in which you are applying. Our adoptions are NOT made on a first-come, first-served basis. Our adoptions are based on the perfect fit for everyone in the family, especially the animal. After you complete this application, follow-up communication is necessary to ensure that the relationship between the dog and the adopter continues to be a good match. We will recieve and review your application. We will then reach out with any questions we may have and to schedule a time to conduct an interview. Interviews are typically done in person, via phone call, or video chat. Meet and greets with the potential family and the animal have to be done prior to determining approval. Please give us up to 72 hours to respond to your application. We perform thorough vet checks and may perform an initial home visit. By completing this applcation, you agree to this condition. Please contact your vet as soon as possible to give them permission to speak with us. If you are renting, we will also verify with your landlord that you are allowed to have pets; this may include requesting documentation from you. All animals will be spayed and neutered prior to being adopted out. If approved for adoption, you must agree to keep us updated upon request with information about the well-being of the dog. If for whatever reason you feel as though you need to rehome this animal at any time, you agree to surrender the dog back to Bruised Not Broken Animal Rescue.

Signature of Potential Pet Parent*