Ultimutt Dog Rescue Application

Please be advised that filling out the application, does not indicate ownership of the animal described below. Often we will receive many applications for the same pet, in which case we will process applications in order of suitability for that pet and availability of the family to adopt.

Please only submit your application if you are ready to adopt upon acceptance. We process our applications promptly and try and get back to you within 24-36 hours.
Name*

First NameLast Name
Todays Date

MonthDayYear
Date
Address*

Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Province*
Postal Code*
Home Phone*

Area CodePhone Number
Cell Phone*

Area CodePhone Number
Email*
example@example.com
Please list the individual(s), ages, work schedule (how long not home?) and their role in the new pet's care *
What do you do for work? How long have you been in this profession or position?
What does your 5 year plans look like in relevance to your schedule and living situation?

The same, no changePossibly moving for work or otherDefinitely travelling but not planning on movingGetting a new jobIf changing living arrangements, briefly describe why below:Other
Marital Status

SingleWidowedCommon LawMarried
If married or common law, how long have you been in this relationship?
Pet's Listed Name that you are applying for*
I would consider my house to be*

HecticNoisyActiveAverageQuiet
My dog needs to be able to adjust to new situations quickly*

Strongly DisagreeDisagreeDoesn't MatterAgreeStrongly Agree
I want my dog to be playful*

Strongly DisagreeDisagreeDoesn't MatterAgreeStrongly Agree
I want my dog to be laid back*

Strongly DisagreeDisagreeDoesn't MatterAgreeStrongly Agree
I am comfortable doing training with my dog to improve proper manners such as jumping, stealing food, and walking on leash.*

Strongly DisagreeDisagreeDoesn't MatterAgreeStrongly Agree
I am comfortable with a puppy that is not yet house-trained*

Strongly DisagreeDisagreeDoesn't MatterAgreeStrongly Agree
I, or a person in my family want to participate in agility, flyball, or obedience training with our dog.*

Strongly DisagreeDisagreeDoesn't MatterAgreeStrongly Agree
My dog may be exposed to other pets (check all that apply)*

Large DogsSmall dogsCatsBirdsOther
My dog may be exposed to (choose all that apply)*

Children under 8Children over 8MenWomenElderly people
My dog may be alone*

More than 9 hours per day4-8 hours per dayLess than 4 hours per dayOther
When I am home, I want my dog to be by my side....*

Little of the timeSome of the timeMost of the time
When I am not at home, my dog will spend his/her time*

In the garageIn a pet safe crateIn the yardLoose in the houseConfined to one room in the houseOther
My dog will spend the night*

In our bedIn a pet safe crate or penIn the yardIn the garageConfined to a room in the houseOther
Where do you live?*

HouseTownhouseApartmentTrailer
Please indicate if you rent or own your dwelling*

RentOwn
***Please note if renting, please attach require a written consent from your landlord stating pets/the breed you are applying for is allowed. This is not just your tenants agreement

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Do you have a private yard? If so, please specify fenced or not*

Yes, fully fenced yardYes, I have a yard but it is not fencedNo yard or not private- describe briefly belowOther
Photos of Where the Adopted pet will be living, this replaces in home visits, please attach photos of your home and yard:*

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Have you lived with cats before?*

NoYes: How long ago? please explain in given paragraph spaceYes: Currently
Yes, I have lived with cats before. How long ago? Please Specify age, sex, indoor/outdoor etc.*
Have you lived with dogs before?*

NoYes: How long ago? please explain in given paragraph spaceYes: Currently
Yes, I have lived with dogs before. How long ago? Please Specify, age, breed, sex *
Do you smoke? *
If you had to move or had a change in your lifestyle due to work, would you ever rehome your pet? If yes, do you have a friend or family that would accommodate? *
Have you ever given up a pet? If yes, why?*
Do you have current pets? If so, please list your pet(s) Name(s)? Breed(s)? Age(s)? Sex(es)*
By applying, we can only assume your pet is friendly with other animals! This is your responsibility, to keep both safe and healthy if you were approved for adoption please indicate if you have any concerns to discuss with our RVT*
My Primary Vet Hospital
Phone Number

Area CodePhone Number
Is your pet up to date on vaccines? Please attach their vaccine certificate for verification

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Do you plan on breeding this pet?

Yes that is the plan!I would have to research firstMaybe, haven't decided for sureNo I am spaying/neutering by 6 months of age and DEFINITELY NOT breeding
Do you authorize us contacting your regular vet if applicable to confirm your current pet's vaccination & prevention status?*
I have called my vet and given permission for you to contact them to ask about my file, please proceed! *
What diet do you plan on feeding? specify if possible ( brand, type, frequency, quantity etc) *
If you have current pets, what do you typically feed them? why? *
What would your routine be, roughly with your new pet, or what is your current routine with your pets? *
What training methods do you prefer?*

Positive reinforcementCorrective basedWith the help of a trainer or professionalI have never trained a dog or puppy
Your thought on using medication for stress and anxiety in pets*

I am open to using pharmaceuticals if my pet exhibits anxiety or stressI am NOT open to pharmaceuticals if my pet exhibits anxiety or stress. They don't need to be drugged!
Would you use any of the following training devices?*

Martingale collar or flat collarProng collar or choke chainElectric or vibration collar handheldHalti head collarHarness/Easy walk harnessI don't restrict my pet, they choose what they want to doOther method describe briefly below:Other
Does anyone in the household have allergies to dogs?*
If yes, please explain how you would manage them:*
In the event that you are not selected to be the owner of the animal described above, would you like us to keep your application on file in case a suitable dog becomes available? *
If yes, would you prefer:*

MaleFemale
What age and size of dog would you prefer?*

Large breedSmall / Medium breedAdultPuppyMust be hypoallergenic
If approved, what is the soonest date you are available to adopt? We will contact you based on suitability and availabilty to adopt*

MonthDayYear
Date
Please be advised that no animals will be adopted out on a "trial basis". Please do your research to ensure you are ready to adopt at this time and are willing to work with your new family member throughout their lifetime. In case of emergency, we will take the pet back within 14 days. Your adoption fee is non-refundable. If the animal becomes ill or is injured during the time s/he is with you, it is your responsibility financially to provide medical care immediately. If you ever need to rehome your adopted pet in the future, please email us at Ultimuttpetrescue@gmail.com for us to assist. A surrender fee may apply.
Signature

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Date

MonthDayYear
Date
Signature or Parent or Guardian if Applicant is under 18

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Personal Reference and who they are to you example: previous adopter from us, family or friend etc
Phone Number

Area CodePhone Number
I understand that I will be contacted via email within 25-36 hours of submitting my application.

I will monitor your email for an email from ultimuttpetrescue@gmail.com to discuss concerns if any and set up a meeting for adoption.
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