Adoption Application

Who are you interested in adopting?*

Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

E-mail*

Employer and Occupation:*

List everyone who lives in your household, including yourself and ages*

Where will the dog stay during the day?*

At night?*

Are you familiar with the use of a pet crate?*

How many hours a day will the dog be left home alone? Where will the dog be?*

Does everyone in the home want a PitBull? Who will be responsible for caring for the dog?*

How will you exercise the dog?*

Is your yard fenced in? Size of yard*

If the yard is not fenced in, how do you plan on safely taking the dog out to potty and exercising?*

Do you rent or own your home?*

If renting, does landlord approve of you owning a pitbull?*

Landlord name:*

Landlord phone number:*

Does your municipality have breed specific restrictions? If so, please describe the nature of the restrictions:*

Please list all current animals living in your home. Include Breed, Name, Gender, Age, Spay/Neuter, Immunizations Up-To-Date, Heartworm Prevention Up-To-Date:*

Please list any dogs/cats you have owned in the past five years, exclude those still living with you. Include Breed, Name, Gender, Spay/Neuter, Source of animal, Years Owned, Where is pet now?*

Veterinarian References: Please supply the name of your current veterinarian, or the one who saw your previous pet(s), with their title identification. If you have never had a veterinarian please select N/A*

Veterinarian Phone Number*

Area CodePhone Number

Of all the breeds available, why do you want a Pit Bull? Please relate any prior experience you have had with the pit bull breed.*

Why are you interested in adopting a new pet at this time?*

Have you ever surrendered a pet to the shelter? If so, why?*

If you travel, will the pet travel with you? If not who will care for the pet while you are away?*

Is seasonal shedding a problem for you or anyone in the home? *

If for any reason you have to move, what will happen to the pet? *

In case of an emergency, such as a hurricane, etc, where will your pet stay?*

Please list a personal reference that can attest to the care of your pets and you love for animals. Please inlduce a phone number.*

Additional Information you would like to share about yourself and your family:

I hereby authorize my Veterinarian/Clinic, listed above, to release any and all information on file under my/dog’s name. This can include, but is not limited to, vaccination history, heartworm prevention/treatment history, release of names and information of dogs that are not listed on this application but listed with my Veterinarian/Clinic.*

I understand that before I decide to adopt, The Pit Stop Rescue will allow the potential adoptee to stay in my home to determine if this is the right match for my family. I agree to absolve The Pit Stop Rescue and all of the representatives from any liability in reference to a dog listed with The Pit Stop Rescue.*

I agree that the dog will not be used in any illegal activities nor be found at any time in a municipality where Pit Bull presence is illegal.*

I agree that the dog is to be kept as a house pet. The dog shall not be sold for any reason. If I can no longer keep the dog, I will contact The Pit Stop Rescue and make arrangements to return the dog to The Pit Stop Rescue.*

If this is for an OUT OF STATE adoption. You are responsible for transportation if approved for adoption.*

For out of state adoptions we do require the adoption contract and adoption donation upon pick up of the dog. However if something does not work out within 7days we will refund you 50%. If things don't work out, we will work with you the best we can on other options for the dog but you are still responsible for the transportation back to the rescue.*

The information provided on this application is correct. I understand that, should I adopt a dog from The Pit Stop Rescue, falsification of any information may result in my returning the animal to The Pit Stop Rescue. I also understand that a member of The Pit Stop Rescue may telephone me periodically or visit my home as a routine post-adoption procedure.*

Prospective Adopter’s Printed Name:*

Date of Application:*

Adoption Application

Please read the following below and initial