Adoption Application

Rakki-Inu Akita Rescue, Inc

Keep in mind that we DO NOT do same-sex adoptions! If you already have a male and female (of any breed), we will not adopt to you! ***Applications that are not fully filled out will not be responded to!!***
Information

If a required field does not apply to you, please answer with "n/a"
Date of Application

MonthDayYearHourMinutesAM/PM Option
Applicant Full Name*

First NameLast Name
Co-applicant Full Name

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number - Home

Area CodePhone Number
Phone Number - Cell

Area CodePhone Number
Phone Number - Other

Area CodePhone Number
E-mail (If you have an e-mail account it will be the primary means of initial communication - Please check it regularly.)*
Specific Orphan you are interested in:
While we cannot choose dogs based on coat length or color, do you have a preference?
Would you consider adopting a long coat Akita?

YesNo
How did you hear about us? Select all that apply

FriendWebsiteWeb search engineMet us at an adoption eventOther
Please list which website, search engine, or by which other means you heard about us:
Have you contacted another rescue group?*

YesNo
Please list the group name and contact person
Rescue group contact phone number

Area CodePhone Number
Rescue group contact E-mail
Describe the type of Akita you are looking for:
Have you owned dogs before?*

YesNo
How many?*
Any large dogs?*

YesNo
Any Akitas?*

YesNo
What breed(s) did you own? What happened to them?*
Do you have any dogs currently?*

YesNo
What is the breed(s)? How old is the dog(s)? Male/female? Is it spayed/neutered? How long have you had the dog(s)?
If current dog(s) are not spayed/neutered, please explain why:
Where did you acquire the dog(s)? (breeder, shelter, friend, etc.)
Would you be interested in fostering?

YesNo
If interested in fostering, have you ever served as a foster for a rescue dog before?

YesNo
If yes, please explain
Do you have any other pets?*

YesNo
If yes, what kind of other pet(s)? Please list
Where did you acquire the pet(s)?
Are your current pet(s) up to date on vaccines?

YesNoNon applicable
Are your current pet(s) kept on heartworm prevention?

YesNoNon applicable
Are your current pet(s) kept on flea prevention?

YesNoNon applicable
Do your current pet(s) receive regular veterinary care?

YesNo
Any potential problems with current pets?
Will the Akita be in contact with any other pets? Please explain
If you are interested in fostering, are you able to keep your foster dog(s) separate from other pet(s)? If so, where?
Why do you want an Akita?*
When are you looking to adopt?

Right awayIn a few weeksOver a month
Did you realize...
Akitas cannot ever be off leash in an open area (such as a park, street, unfenced yard)?

YesNo
Akitas can be dog aggressive and normally do not get along with a dog of the same sex?

YesNo
Akitas have a strong prey drive and can hurt small animals such as rabbits and cats?

YesNo
Akitas should not be tied out in the yard?

YesNo
Akitas blow their coats twice a year?

YesNo
Akitas are naturally dominant and need to go to obedience training with their owner?

YesNo
Akitas normally live to be 10-15 years old and need a commitment for that long?

YesNo
Many insurance companies maintain lists of excluded breeds of dogs. These lists typically include Akitas, along with many others. This means that if you have one of these breeds, an insurance company may: 1. Refuse to write an insurance policy at all. 2. If you currently have a policy, and they learn that you have one of these breeds, they may revoke your insurance. 3. If there is a personal liability claim relating to your dog, such as an instance where someone is bitten by your dog, they may refuse the claim, in which case the liability would fall upon you. If damages were awarded by a court of law, this could represent a significant financial burden. It is your responsibility to determine whether or not your insurance provider has such a provision in your policy or not, and whether your personal liability is adequate to cover you in the event of a claim, and we urge you to review your policy with your agent to make these determinations.

YesNo
Do you still think that the Akita is the right dog for you?

YesNo
Home and Family

If a required field does not apply to you, please answer with "n/a"
How long have you been at your current address?*
Do you rent or own?*

RentOwn
Do you have a Home Owner's Association?

YesNo
If yes, do they allow Akitas?

YesNo
Do you have Home Owner's Insurance?

YesNo
If yes, do they allow Akitas?

YesNo
Home Owner's Insurance Company
Agent name

First NameLast Name
Agent contact number

Area CodePhone Number
If renting, does the lease permit large dogs?

YesNo
Landlord / leasing agent / apartment complex name
Phone Number

Area CodePhone Number
Size of the lot
Is the lot fenced?*

YesNo
Is the lot full or partially fenced?

Fully fencedPartially fenced
If yes, what is the fence material and fence height?
Do you have plans to move?

YesNo
When and where?
Do you have a crate available?

YesNo
Do you have a kennel available?

YesNo
Are you willing to buy a crate or kennel?

YesNo
Number of people in the household and their relationship to you
Are there children in the household?*

YesNo
If yes, how many children and what are their ages?
Are the children dog trained?

YesNo
Is anyone in the household allergic to dogs?

YesNo
Is anyone in the household afraid of large dogs?

YesNo
How do the children react to dogs?
Are there grandchildren, stepchildren, relatives with children, or any other children that visit regularly?*

YesNo
Will the Akita be in contact with these or any other children? If yes, explain
Is anyone in the household in the military?*
If you had a pet in the past, what happened to it when you were deployed?
If you adopt a dog and then are deployed, what will you do with the dog?
Have you taken your pets with you when you were transferred? Even overseas?
If not, what arrangements did you make for your pet?
If you adopt a dog and get transferred, what will you do with the dog?
Are you single?*
What will you do if you become involved with someone who does not like or is afraid of your dog?
What will you do if you become involved with someone who has children who are afraid or allergic to your dog?
What will you do if you become involved with someone who is or becomes allergic to your dog?
What will you do with your dog if you break up or divorce?
If you are childless, do you plan on having children during the lifetime of your dog?
What will you do with your dog if you have children?
Expected Routine
How much time will be spent with the Akita daily: Weekdays?
How much time will be spent with the Akita daily: Weekends?
How many hours will the Akita be left alone daily?

0-2 Hours2-4 Hours4-8 Hours8+ Hours
Are there any other people who might be in and out of your house when you are not there?

YesNo
If yes, please explain
Where will the Akita be when you are at work?
Where will the Akita Sleep?
When will the Akita be outside?
Will the Akita be tied out?

YesNo
How often will the Akita be walked?
Where?
By whom?
How often will the Akita be played with?
By Whom?
How often will the Akita ride in the car?
Will the Akita be crated or restrained?
Will you take the Akita to obedience training?

YesNo
Where will the Akita be when you are away overnight?
Are there any unusual circumstances that the Akita will need to adapt to?
Other comments about daily routine:
References

If a required field does not apply to you, please answer with "n/a"
Are you, or anyone else in the household, currently employed?*
If no, what is your alternate source of income?
Company / Employer Name (1)
Address
City / State / Zip
Phone Number

Area CodePhone Number
Occupation / Job title
Years at present job
Who in the household is employed at this job?

First NameLast Name
Company / Employer Name (2)
Address
City / State / Zip
Phone Number

Area CodePhone Number
Occupation / job title
Years at present job
Who in the household is employed at this job?

First NameLast Name
Do you have a current veterinarian?
Name of current veterinarian/ name of vet clinic:
Veterinarian phone number

Area CodePhone Number
Local Animal Control*
Animal Control Phone Number*

Area CodePhone Number
Local Animal Shelter*
Animal Shelter Phone Number*

Area CodePhone Number
Do you have a dog trainer?
Current Trainer
Current Trainer Phone Number

Area CodePhone Number
Personal References (only one should be a family member)

If a required field does not apply to you, please answer with "n/a"
Personal Reference #1*
Phone number*

Area CodePhone Number
Relationship to reference #1*
Personal Reference #2*
Phone Number*

Area CodePhone Number
Relationship to reference #2*
Applicant Disclosure
Do you feel financially secure to care for an Akita for its lifetime?*

YesNo
Do you feel physically able to care for an Akita for its lifetime?*

YesNo
Have the police been at your home for any disturbances?*

YesNo
If yes, please explain:
Do you, or anyone in your family or living at the above listed residence, have a history of animal, child, or spousal abuse?*

YesNo
Have either you or the co-applicant currently filing, about to file, or filed for bankruptcy within the past 5 years*

YesNo
If yes, please explain
Are you informed of local zoning and dog ownership ordinances?*

YesNo
Will you be in compliance?*

YesNo
Please list any additional information about your home that has not been covered in this document:*
Disclaimer

By sumbitting this application you are stating that you are at least 18 years of age and that you fully understand that any misrepresentation of yourself or any untruths herein this application that are discovered at a later date will invalidate any adoption agreement, disqualify you from being an adopter from RIAR, and RIAR will immediately remove, without notice, any and all RIAR dogs from your care. In addition, by submitting this application you are stating that you fully understand that any misrepresentation of yourself or any untruths herein this application that are discovered at a later date that disqualify you from being an adopter may be shared with other humane organizations if they query RIAR.
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Rakki-Inu Akita Rescue, Inc

Information

Did you realize...

Home and Family

Expected Routine

References

Personal References (only one should be a family member)

Applicant Disclosure

Disclaimer