The Right To Live Adoption Application

Name of Dog you are interested in

Applicant Name *

First Name Last Name

Birthdate *

Address *

Street Address

Street Address Line 2

City State

Zip Code

Length of time at present address *

If lived at current address less than 1 yr, list previous address

Home phone *

Area Code Phone Number

Cell phone *

Area Code Phone Number

Email Address *

Are you presently: *

Employed Retired Student Work at Home/Stay Home Parent

Employer (if applicable)

Work phone

Area Code Phone Number

Full names of other adults living in your household. List children and ages if applicable. *

Do all the adults in the household agree to the adoption? *

Yes No

Is anyone in your home allergic to animals? *

Yes No

Co-Applicant Name

First Name Last Name

Birthdate

Relationship to Applicant

Home phone

Area Code Phone Number

Cell phone

Area Code Phone Number

Email Address

Are you presently:

Employed Retired Student Work at Home/Stay Home Parent

Employer (if applicable)

Work phone

Area Code Phone Number

Type of Residence *

Single Family Home Duplex/Twin Condo/Townhome Apartment

Do you rent or own your home? *

Rent Own

Name of Complex/Landlord (if renting)

Phone number of Complex/Landlord

Area Code Phone Number

List any breed restrictions/weight restrictions for dogs where you live, if any. *

Where will the dog live? *

Inside Only Outside Only Mostly Inside Mostly Outside

Where will the dog spend the night? *

Inside Outside

Do you have a fenced yard? *

Yes No

If yes, type of fence and height *

Will the dog be on a chain or tether while outside? *

How many hours a day will the dog be alone/where will the dog stay during that time? *

Who will be the primary caretaker of the dog? *

What type of physical exercise will you provide for the dog? *

What methods of training will you provide for the dog? Will the dog attend any obedience classes? *

What method of training will you use to house train your dog? *

How do you/would you discipline your pet? For what reasons? *

How much time are you prepared to allow your new dog to adjust to your home? *

When you are away, who will care for the dog? *

Have you ever had a pet euthanized? If so, for what reason? *

Have you ever lost a pet due to an accident? If so, please explain. *

Under what circumstances would you consider rehoming the dog? *

Have you had pets within the last 5 years? *

Please list each pet with name, age, breed and years owned *

Were/are your pets spayed/neutered? If not, please explain. *

Were/are your pets current on vaccinations? *

Were/are your pets on Heart worm preventative? *

If not on Heartworm preventative, please explain why. *

Do you know what brand of dog food you will feed your dog? If not, what brands will you likely consider? *

Are you financially able and willing to pay for the care and medical needs a dog will require? *

Do you consider your dog a part of your family? *

Are you aware that owning a dog is a big responsibility and a lifelong commitment? *

Name, address and phone of past or current Veterinarian *

Reference #1 (not related to you) Name and phone number *

Refernce #2 Name and phone number *

Would you be interested in fostering a dog for The Right To Live?

Yes No

Additional Comments

All of the information I have given is true and complete. This dog will reside in my home as a pet. I will provide it with quality dog food, plenty of fresh water, indoor shelter, affection, annual physical examination and vaccinations under the supervision of a licensed Veterinarian. *

I agree I do not agree

I acknowledge that this dog is a rescue, and most likely a stray and therefore THE RIGHT TO LIVE has no knowledge about the dog's ability to get along with people, children, other dogs and cats beyond our limited experience with the animal at our rescue. I also acknowledge that this rescue dog comes with no medical history other than what was observed or detected in the shelter *