Adoption Application Form

Full Name

First NameLast Name

Age

E-mail

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number - Home

Format: (000) 000-0000.

Phone Number - Cellular

Format: (000) 000-0000.

Do you live in a:

Do you:

If renting: please indicate landlord contact information

Household Setting

Describe your home's activity level

Please list all people living in the household (Include name, relationship, gender and age)

Does anyone in your household have allergies to animals?

Are all members of your household agreeable to adopting a dog?

Please list any pets you have living or deceased (Please include name, breed, age, altered, sex, UTD vaccines, heartworm, living/deceased)

Do you have a preference in sex of adoption dog?

Are you willing to adopt a dog of any age?

If not, what age would you consider?

What size dog are you willing to adopt? (Check all that apply)

Why do you want to adopt a dog? What type of characteristics are you looking for in a dog? We always want to make sure we have the best fit for our foster homes.

Are you willing to take your dog to vet appointments?

If No please explain

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

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

If Yes please explain

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

Do you have a fenced yard?

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?

What are you plans to exercise your dog? Please list any parks near by or trails, how many walks a day, approximate length, and activities such as agility.

Please list at least 2 personal references with names, addresses, phone numbers and how related. We prefer it not to be all relatives. Are you ok with this?

Vet Reference: Full Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Format: (000) 000-0000.

Reference #1: Full Name

First NameLast Name

Relation to applicant(s):

E-mail

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Format: (000) 000-0000.

Reference #2: Full Name

First NameLast Name

Relation to applicant(s):

E-mail

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Format: (000) 000-0000.

Reference #3: Full Name

First NameLast Name

Relation to applicant(s):

E-mail

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Format: (000) 000-0000.

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 ROSEBUD RESCUE ALLIANCE animal 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 ROSEBUD RESCUE ALLIANCE and it's members from any claims, damages, costs, or actions incurred because of the care or actions of the adoptive dog.

I accept full responsibility for the dog(s) actions at all times, and release ROSEBUD RESCUE ALLIANCE from any liabilities or damages that may be incurred because of adopting such dog(s).

I agree to have ROSEBUD RESCUE ALLIANCE complete reference call checks and conduct a home visit inspection to be able to approve my foster application.

I agree that if I'm unable to house the dog(s) anymore that I will return the dog(s) to ROSEBUD RESCUE ALLIANCE.

Date

MonthDayYear

Your name

E-mail

example@example.com