Foster/Adoption Application

How did you hear about A Rottie Rescue, Inc.

Full Name*

First NameLast Name

Age

E-mail*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number - Home

Area CodePhone Number

Phone Number - Cellular

Area CodePhone Number

Phone Number - Work

Area CodePhone Number

Do you live in a:

Do you:

OwnRentLive with ParentsOther

If renting please provide Landlord contact information. Are there Breed Restrictions imposed by the Landlord or HOA if your own your home

Household Setting

RuralSuburbanUrban

Describe your Homes Activity Level

Busy/NoisyModerate Comings/GoingsQuiet with Occasional Guests

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

Does Anyone in your Household have Allergies to Animals?

YesNo

Are all members of your Family agreeable to Fostering/Adopting a Dog?

YesNo

Please List all Pets living at the home. Please include Name, Breed, Age, Gender, Neutered or Spayed, and if up to date on Vaccines*

Where will the dog stay when you aren't home?

Have you ever crate trained a dog?

YesNo

Have you ever house trained a dog?

YesNo

Where will the dog stay at night?

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

YesNo

Have you had any experience with with an emotionally or physically neglected or abused dog?

YesNo

If Yes please explain

Are you willing to use a crate for a dog if recommended?

YesNo

Do you have a fenced yard?

YesNoPartial

If fenced, please give details on height, material, # of gates, are gates locked or lockable?

How many hours in a day would the dog be left alone?

Name or Description of the dog you want to foster/adopt

Please list 3 personal references with names, addresses, phone numbers and how related. We prefer it not to be all relatives. Are you ok with this?

YesNo

Vet Reference: Full Name*

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Reference #1: Full Name*

First NameLast Name

Relation to applicant(s):

E-mail

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Reference #2: Full Name*

First NameLast Name

Relation to applicant(s):

E-mail

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Reference #3: Full Name

First NameLast Name

Relation to applicant(s):

E-mail

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully. I understand that applying does not ensure approval and that untruthful answers or failure to comply with the requirements of this application can result in the forfeiture of any A ROTTIE RESCUE, INC. animal fostered/adopted by me. I certify that the above information is correct, and I understand that the information will be verified. I understand that by submitting this form electronically, I agree to release and covenant to hold harmless A ROTTIE RESCUE, INC. and it's members from any claims, damages, costs, or actions incurred because of the care or actions of the foster/adopted dog. I accept full responsibility for the dog(s) actions at all times, and release A ROTTIE RESCUE, INC. from any liabilities or damages that may be incurred because of fostering/adopting such dog(s). I agree to have A ROTTIE RESCUE, INC. complete reference call checks and conduct a home visit inspection to be able to approve my foster/adopter application. I agree that if fostering a dog for A ROTTIE RESCUE, INC. I am not able to make medical decisions for the foster dog and A ROTTIE RESCUE, INC. must approve all Veterinarian expenses for the foster dog or they will not be paid or reimbursed by A ROTTIE RESCUE, INC.

Date

MonthDayYear

Your name*

E-mail