The Right To Live Adoption Application
Name of Dog you are interested in
Applicant Information
Applicant Name
*
First Name
Last Name
Birthdate
*
Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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 Information
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
General Information
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?
*
Pet Information
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
*
Personal References
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
Acknowledgements
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
*
I Agree and Understand
I DO NOT Agree and Understand
I acknowledge that the stated age of my adopted pet is determined by a city shelter veterinarian to the best of his/her ability, having no previous history of the dog. I understand that the age is not always accurate and that I should consult my own veterinarian for determination or confirmation
*
I Agree and Understand
I DO NOT Agree and Understand
I understand that my dog may have been exposed to illness from other dogs in the shelter and may be incubating a disease. I RELEASE THE RIGHT TO LIVE FROM ALL RESPONSIBILITY regarding the health of your dog. I acknowledge that, on the day I take ownership of the adopted dog, I am solely responsible to provide and pay for veterinary care for my dog
*
I Agree and Understand
I DO NOT Agree and Understand
I understand I will need to follow up with my veterinarian to obtain future vaccinations for my adopted animal. I understand that in accordance with municipal and state law, I will continue to keep my pet's rabies vaccination current
*
I Agree and Understand
I DO NOT Agree and Understand
I agree and understand that if I am currently a tenant living in rental housing, I will comply with any lease requirements, including but not limited to payment of a pet deposit my landlord may require in order to have my adopted pet(s) on the premises
*
I Agree and Understand
I DO NOT Agree and Understand
I agree that I am submitting my application through email and electronically entering my information, that said email and typing of name above serves as agreement and release of all conditions stated
*
I Agree and Understand
I DO NOT Agree and Understand
I agree that I will return a dog to The Right to Live Rescue if I can no longer care for said dog.I agree I will not give the dog to another person without the rescue approval, I agree I will not surrender said dog to a Shelter .
*
I Agree and Understand
I DO NOT Agree and Understand
I understand that when adopting a dog, especially when recently released from a shelter environment, there are certain risks involved. I understand that THE RIGHT TO LIVE , and volunteers of THE RIGHT TO LIVE , provide the information they have been given by the shelter on behalf of the animals being adopted in good faith and are not responsible in any way for any issues that may arise in conjunction with adoption or ownership thereafter
*
I agree and Understand
I DO NOT Agree and Understand
I UNDERSTAND THE RIGHT TO LIVE ' ADOPTION FEE IS NON-REFUNDABLE
*
I Agree and Understand
I DO NOT Agree and Understand
By signing below, I affirm that I have answered the above questions truthfully and honestly.
Signature of Applicant
*
Signature of Co-Applicant
Date
*
Submit
Should be Empty: