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"
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Applicant Full Name
*
First Name
Last Name
Co-applicant Full Name
First Name
Last Name
Address
*
Street Address
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City
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Please Select
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Country
Phone Number - Home
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Area Code
Phone Number
Phone Number - Cell
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Area Code
Phone Number
Phone Number - Other
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Area Code
Phone 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?
Yes
No
How did you hear about us? Select all that apply
Friend
Website
Web search engine
Met us at an adoption event
Other
Please list which website, search engine, or by which other means you heard about us:
Have you contacted another rescue group?
*
Yes
No
Please list the group name and contact person
Rescue group contact phone number
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Area Code
Phone Number
Rescue group contact E-mail
Describe the type of Akita you are looking for:
Have you owned dogs before?
*
Yes
No
How many?
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Any large dogs?
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Yes
No
Any Akitas?
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Yes
No
What breed(s) did you own? What happened to them?
*
Do you have any dogs currently?
*
Yes
No
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?
Yes
No
If interested in fostering, have you ever served as a foster for a rescue dog before?
Yes
No
If yes, please explain
Do you have any other pets?
*
Yes
No
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?
Yes
No
Non applicable
Are your current pet(s) kept on heartworm prevention?
Yes
No
Non applicable
Are your current pet(s) kept on flea prevention?
Yes
No
Non applicable
Do your current pet(s) receive regular veterinary care?
Yes
No
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 away
In a few weeks
Over a month
Did you realize...
Akitas cannot ever be off leash in an open area (such as a park, street, unfenced yard)?
Yes
No
Akitas can be dog aggressive and normally do not get along with a dog of the same sex?
Yes
No
Akitas have a strong prey drive and can hurt small animals such as rabbits and cats?
Yes
No
Akitas should not be tied out in the yard?
Yes
No
Akitas blow their coats twice a year?
Yes
No
Akitas are naturally dominant and need to go to obedience training with their owner?
Yes
No
Akitas normally live to be 10-15 years old and need a commitment for that long?
Yes
No
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.
Yes
No
Do you still think that the Akita is the right dog for you?
Yes
No
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?
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Rent
Own
Do you have a Home Owner's Association?
Yes
No
If yes, do they allow Akitas?
Yes
No
Do you have Home Owner's Insurance?
Yes
No
If yes, do they allow Akitas?
Yes
No
Home Owner's Insurance Company
Agent name
First Name
Last Name
Agent contact number
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Area Code
Phone Number
If renting, does the lease permit large dogs?
Yes
No
Landlord / leasing agent / apartment complex name
Phone Number
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Area Code
Phone Number
Size of the lot
Is the lot fenced?
*
Yes
No
Is the lot full or partially fenced?
Fully fenced
Partially fenced
If yes, what is the fence material and fence height?
Do you have plans to move?
Yes
No
When and where?
Do you have a crate available?
Yes
No
Do you have a kennel available?
Yes
No
Are you willing to buy a crate or kennel?
Yes
No
Number of people in the household and their relationship to you
Are there children in the household?
*
Yes
No
If yes, how many children and what are their ages?
Are the children dog trained?
Yes
No
Is anyone in the household allergic to dogs?
Yes
No
Is anyone in the household afraid of large dogs?
Yes
No
How do the children react to dogs?
Are there grandchildren, stepchildren, relatives with children, or any other children that visit regularly?
*
Yes
No
Will the Akita be in contact with these or any other children? If yes, explain
Is anyone in the household in the military?
*
Please Select
Yes
No
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?
*
Please Select
Yes
No
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 Hours
2-4 Hours
4-8 Hours
8+ Hours
Are there any other people who might be in and out of your house when you are not there?
Yes
No
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?
Yes
No
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?
Yes
No
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?
*
Please Select
Yes
No
If no, what is your alternate source of income?
Company / Employer Name (1)
Address
City / State / Zip
Phone Number
-
Area Code
Phone Number
Occupation / Job title
Years at present job
Who in the household is employed at this job?
First Name
Last Name
Company / Employer Name (2)
Address
City / State / Zip
Phone Number
-
Area Code
Phone Number
Occupation / job title
Years at present job
Who in the household is employed at this job?
First Name
Last Name
Do you have a current veterinarian?
Please Select
Yes
No
Name of current veterinarian/ name of vet clinic:
Veterinarian phone number
-
Area Code
Phone Number
Local Animal Control
*
Animal Control Phone Number
*
-
Area Code
Phone Number
Local Animal Shelter
*
Animal Shelter Phone Number
*
-
Area Code
Phone Number
Do you have a dog trainer?
Please Select
Yes
No
Current Trainer
Current Trainer Phone Number
-
Area Code
Phone 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 Code
Phone Number
Relationship to reference #1
*
Personal Reference #2
*
Phone Number
*
-
Area Code
Phone Number
Relationship to reference #2
*
Applicant Disclosure
Do you feel financially secure to care for an Akita for its lifetime?
*
Yes
No
Do you feel physically able to care for an Akita for its lifetime?
*
Yes
No
Have the police been at your home for any disturbances?
*
Yes
No
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?
*
Yes
No
Have either you or the co-applicant currently filing, about to file, or filed for bankruptcy within the past 5 years
*
Yes
No
If yes, please explain
Are you informed of local zoning and dog ownership ordinances?
*
Yes
No
Will you be in compliance?
*
Yes
No
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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