Dog Adoption Application

Thank you for being interested in adopting a pet from us! The following information is requested so that we can assist you in the selection of your new dog. This form and consultation with a Ruff Patches representative are designed to help us determine the right pet for you and your family!

PLEASE NOTE: We are an all-volunteer organization and have received a huge increase in requests for adoptions, fostering, and assistance. It's keeping us busy! Right now the waiting time for a response is 5-7 days, but we are catching up as quickly as we can. Thank you for your understanding and patience!
Name of the Dog You are Interested in:*
First Name:*
Last Name:*
Please state your birth date (to verify you are over 18 years old). We will not save this information and your privacy is very important to us!*

MonthDayYear
Email:*
Phone # 1*
Phone # 2
Street Address*
City*
State*
Zip Code*

Pets in the Home
Do you currently have other pets?*

YesNo
Please list the details of each current pet - breed, sex, if they have been spayed or neutered and age.
If you had other pets in the past, what happened to those pets? Please provide details.

How did you hear about Ruff Patches?
If you would like to make any further comments, please feel free to add them below.
Would you like to receive our e-mail newsletter? We respect your privacy and would never give away or sell your information to anyone!*

Yes, please! Keep me up to date with your life saving work!No, thank you. Not right now.
Agreement * I understand that filling out this application does not guarantee the adoption of a pet from Ruff Patches. I agree that all of the above information is honest and true.*

Yes
Should be Empty:

About You