CBHBB Adoption Application 7-16

Carolina Big Hearts Big Barks Rescue Adoption Application
Contact Information
Name

First NameLast Name
E-mail
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
How long have you been at this address?
Best Contact Number

Area CodePhone Number
Best Time to Call
Occupation
Name of the Dog You are Interested in Adopting?
Family and Housing
How many adults are in your household, and what is their relationship to you?
How many children? Ages?
In what type of dwelling do you reside? (single family, apartment, condo, farm, etc)
Do you OWN or RENT? *
If you own-Do you have a Home Owner's Association in your community?*
What is the NAME of your community?
If you have an HOA, please provide contact information to check convenants.
If you RENT, please provide your landlord or leasing office information.
Describe your household
By providing this information you are authorizing us to call and speak with your landlord/leasing office/rental agency. It's best to call ahead and let them know so that they will speak with us.
Does anyone in your household have a known allergy to dogs?
Does everyone in the household agree to adopt the dog?
Do you feel you have adequate time to provide love and attention?
Other Pets
Tell us about the other pets you have in your home. This includes any pets you have had in the last 3 years.*
If you answered NO to spayed/neutered, current on vaccinations, or that the pet is no longer with you above, please explain.
Have you ever surrendered a pet?
If yes, please explain
Have you ever had a pet euthanized?
If yes, please explain
Have you ever lost a pet to an accident?
If yes, please explain
How do you discipline your pets and why?
Veterinarian Information

It is important that you ACCURATELY list the veterinarian information for your CURRENT vet. That means the vet where your pet has been most recently seen, in addition to the vet that will have the most current vaccination information. Use the notes portion of this section to offer any additional information. We DO check vet references (even for pets you have listed as deceased) so please be thorough.
Do you have a regular veterinarian?*
Veterinarian's Name
Clinic Name
Clinic Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Any additional info about vetting you need to include (for example: the records are in your spouse's name, etc)
By providing CBHBB with this information you are authorizing us to call your vet. Please call ahead and authorize the release of information.
About the Dog You Wish to Adopt
What is your ideal dog and why?
Desired Age
Desired Size
Desired Breed
Breed you would not adopt
Desired Sex
outgoing/hyper dogdog that needs regular medicationdog that needs groomingshy dogdog that needs trainingnone of these
Where will the dog spend the day? (please describe)
Where will the dog spend the night? (please describe)
Average number of hours the dog will spend alone?
Who will have the primary responsibility for this dog's daily care?
Who will have the financial responsibility for this dog?
Do you agree to provide regular vet care from a licensed veterinarian?
Do you agree to keep this dog as an INDOOR dog?
When the dog goes outside, how do you plan to supervise? (fenced yard, leash, etc)
Do you agree to contact CBHBB FIRST if you can no longer keep this dog?
Are you willing to let a representative of CBHBB visit your home by appointment?
Personal References

Please provide at least one NON-RELATIVE
Name

First NameLast Name
Phone Number

Area CodePhone Number
Relationship (relative, friend, neighbor, etc)
Name

First NameLast Name
Phone Number

Area CodePhone Number
Relationship (relative, friend, neighbor, etc)
How did you hear about Carolina Big Hearts Big Barks Rescue?
Would you be interested in fostering?
By clicking "submit" I am asserting that all of the information I have given is true and complete. The dog will reside in my home as a pet. I am agreeing to provide quality dog food, fresh water, indoor shelter, affection, annual physical examination, and vaccinations under the supervision of a licensed veterinarian.
Should be Empty:

Carolina Big Hearts Big Barks Rescue Adoption Application

Contact Information

Family and Housing

Other Pets

Veterinarian Information

About the Dog You Wish to Adopt

Personal References