The Rustic Mutt Dog Adoption Application

If you live with a spouse or partner, please discuss this dog with them before submitting an application to be sure they are in agreement about adoption.
Please help us determine where our marketing is working best. Where did you see this dog's listing?*

AdoptAPetPetfinderRescueMeFacebookOther
Name of the dog you want to adopt
What drew your attention to this particular dog?
Vet reference (please call your vet and give permission to release information to us)*
Adopter's Name*
First & Last Name
Co-Adopter's Name
First & Last Name
Adopter's Email*
Address*

Street Address

Street Address Line 2

CityState

Zip
Co-Adopter's Email
Phone Number*

Area CodePhone Number
Phone Type*

CellHomeWork
Names and ages of all permanent residents of your home (adults/children)*
Current pets in your home*
Are your current pets altered (spayed/neutered)?*

YesNo
If you answered no above, why are they not altered?
How often does your dog see the vet and for what reasons? (check all that apply)*

Once a year without failEvery couple of yearsWhenever there's an illness or injuryWe do annual heartworm/lyme testingWe do annual fecal testingWe vaccinate annuallyWe vaccinate every 3 yearsWe titer annuallyWe vaccinate less than every 3 yearsWe vaccinate for rabiesWe vaccinate for lyme
What do you use for flea/tick preventative?*
When will you be ready to adopt this dog?*

TodayThis weekendWithin a weekNot ready yet, just researching (Please don't submit this app, email us instead and let us know how we can help you.)
Are you in contact with any other rescues or shelters about a specific dog?*

Yes, application is pendingYes, we are approved to adopt from another rescueYes, but I am looking to adopt two dogsYes, just an email inquiry, no app yetNo, but I am looking at several dogs onlineNo, I am only interested in this particular dogI'm really not sure what dog I want. Haven't fallen "in love" with any particular dog's bio yet. So I may be applying to multiple rescues/shelters.
Is anyone in your home allergic to dogs?*

YesNo
How much effort are you willing to put into helping this dog adapt to your home/family/lifestyle?*

None, I want an easy/perfect dogSome, but not very much. Dog should settle in within a week and be issueless.I understand that dogs have emotions and issues just like people, that each dog is different and will have different training and emotional needs.I always take my newly adopted dogs to a trainer who uses positive-motivation training methods.
Are you familiar with dog regulations in your area?*

YesNo
If you answered no to the question above, please contact your town/county/condo assoc and ask them what the regulations are.
I/We live in a*

Single Family HomeDuplex/TwinCondo/TownhomeTrailerApartmentOther
Do you rent or own this property?*

RentOwn
If you rent, you must show us a written letter from your landlord or a copy of the section of your lease stating that you are allowed to have dogs and showing any limitations.

If you live in a condo or townhome, you must show us written proof that you are allowed to have a dog there and show any restrictions.

This written proof can be emailed to us as a photo attachment.
Do you have a yard?*

Yard, fenced with a vertical fenceYard, fenced with invisible fencingYard, no fenceNo yard (apartment/condo/townhome)
If fenced, fence height is:

2' high3' high4' high5' high6' highUnderground wire/invisible fencing
Do you work outside the home?*

YesNoOne applicant is home/works from homeOther
Have you discussed this adoption with all members of your household?*

YesNoYes, adults have discussed. Kids don't know yet.Other
We will be speaking to all household residents to confirm everyone is aware of this application process and wants to have a dog added to the family. Please do not submit this application if you are "trying to talk someone into" adopting this dog or think "once they meet the dog, they will want one" or "I'm getting this dog as a birthday present for them." In those scenarios, you are welcome to email us to discuss the dog, but we would like all adults in the home to be involved in that email discussion.
Fantasy question: What would your dream dog be like? (If this dog is not a fit, we may be able to recommend another based on what you say here.)*
I want a dog that:

Is already housebroken.Is already leash trained.Is old enough that it's past the puppy/chewing stages.Does not need to be crated when I am home.That I can train myself. I don't mind housebreaking or doing obedience training myself.That really needs a good home, regardless of what issues it may have (health/training needs).Is already crate trained.That needs a lot of exercise.That doesn't need a lot of exercise.That will travel with me often.That I can take to work and it will be well behaved.That I can take camping.That needs work on socialization and training. I love rehabbing dogs with issues.That I can train as a therapy dog.That matches my furniture or carpet.That doesn't make nose prints on the window.Will happily tolerate my young children climbing all over it, hugging and kissing.That rides well in the car without being nervous or getting carsick.Never shedsHas low maintenance/grooming needsNever barksNever growlsOther
If you have children under the age of 10, check all that apply and list their ages in the last row*

We do not have children under the age of 10 living hereWe have children under the age of 10 visiting frequently but not living here full timeWe only occasionally have children under the age of 10 visiting usThis will be my children's first petMy children have not been around dogs regularlyMy children have been around other family members dogsMy children have been around large dogsMy children have lived with large dogsMy children have been around small dogsMy children have lived with small dogsMy children want a dog to sleep in bed with themMy children think hugging and kissing a dog is great funMy children like to pull a dog around by the collarMy children will encourage our new dog to jump up on them for attentionMy children are generally gentle and quietMy children are generally gentle but somewhat noisyMy children are really not gentle with dogs so need a tolerant dogMy children are pretty loud and rough so we need a dog that won't be scared of that kind of behaviorI do not allow my children to climb on dogsI do not allow my children to pull a dog's ears or tailI do not allow my children to hug dogs.I do not allow my children to kiss a dog on the face or head.We do not plan to do any training, so we need a dog that is already trained.We do not plan to do any housebreaking, so need a dog that is already housebroken.One of my children has been bitten by a dog in the pastOne of my children is afraid of large dogsOne of my children is afraid of small dogsMy children have attended classes with a dog trainer in the pastWe are going to attend classes with a dog trainer as a family so everyone learns the same way to trainOther
What activity level do you prefer?

Wild and crazy is coolLeash trained daily jogging partner would be excellentMedium energy, plays a bit then hangs out with youLow energy, walks slowly on leash, a total couch potatoOther
Please check all that apply. I want to adopt this dog...*

As a family petTo breed with my dogTo train/use for huntingTo train/use for agilityTo train/use as a therapy dogTo train/use as an assistance dog for the disabledTo use as a guard dogFor a jogging/hiking partnerTo interact with lots of friends/familyAs a gift for a friendAs a companion for my dog(s)As a companion for my cat(s)As a companion for my child/children
Please check all that apply. My adopted dog will...

Be kept outside most of the timeBe kept indoors most of the timeBe left outside during the work day while we are awayBe kept inside while we are awayBe crated when we are not homeHave free reign of the house when we are not homeBe taken to formal obedience classesBe trained by me/usTake frequent car rides with usBe kept on a lead line/cable in the yardBe mostly interacting with adultsBe interacting frequently with children under 8Be interacting frequently with older childrenMust be housebroken prior to adoptionWill be housetrained by usWe be walked more than one mile per day every dayWill be walked occasionallyBe attending formal group obedience classes with usBe trained by us without the advice of a trainerHave private sessions with a trainer as neededBe attending agility classesBe taking frequent car rides/trips with usBe boarded when we go on vacationStay with family when we go on vacationBe returned to your organization if we can't keep itBe given away to someone else if we feel it's not a good match for usBe turned in to a shelter if we can't keep itBe going camping with usBe going on boat trips with usOther
Please take time to think, be honest with yourself and us when answering this question. What are you absolutely NOT willing to deal with at the time of adoption or at any time during the life of the dog?*

HousebreakingChewingJumpingCrate TrainingPulling on leash during walksCounter surfingObedience trainingFear of menFear of womenFear of childrenMouthiness (may sometimes snag your hand or arm instead of the toy in play and will need redirection/training)GrowlingBarkingRough play with my dogLeash trainingHigh activity levelFood/toy aggression/not willing to share with other dogsFood/toy aggression with peopleWhining/cryingObedience TrainingCounter surfingBlindnessLimited SightDeafnessSeparation Anxiety (gets upset when left alone)DiabetesSpecial DietLong Term MedicationIncontinence / Leaking UrineTaking classes with the dogGets stressed/carsick when riding in vehicleDoesn't know how to climb stairsCan't climb stairs due to age/arthritis/health issuesHeart conditionSkin allergiesFood allergiesTrimming nailsYeast on coat or in earsEar mitesFleasTicksHeartworm preventativeAnnual heartworm/lyme combo testingI will do whatever it takes to help this dog adjust and work with a trainer to help resolve any training needs.Other
What would cause you to return a dog?*
What would you do if at any time during the life of the dog your vet diagnosed an expensive health condition?*
How long have you been looking for a dog?*
Do you have any additional comments, questions or concerns? Anything else you would like us to know to help match you up to a dog?*
I understand the adoption fee is $300*

YesNoI can't afford that.This dog has a discounted adoption fee in their listing that I am eligible for.Other
Please note: All responses to applications are via email, usually within 24 hours. Please check your email 6-24 hours after submitting this application.

Applicant Agreement

Please read before signing!

If you have any current pets, please contact your vet and advise them that we will be calling for a vet reference. We will need to know if your current pet(s) are altered and up to date on their vaccinations. We will also need to know how frequently you take your animals in to the vet for an examination. Veterinarians will not release this information without your permission. Please email us after you have made this call so that we know your vet will release the information to us. Your vet may require written permission from you prior to releasing this information.

By signing below, you are giving permission for us to use the information on this application to contact your references and veterinarian and you give permission for your veterinarian to release your pets' medical records to our rescue. You also agree to a home visit as part of the adoption process.

By signing below, you certify that you have read, understood, agree with, and will comply with our adoption policies. You further certify that the information you have provided on this form is true, correct, and complete. You understand and agree that falsification of any of the above information or any information disclosed during the review process is grounds to disqualify your adoption application and nullify all adoption(s) and/or adoption agreements between you and us. By checking the box below, you certify that this is your electronic signature guaranteeing that everything you say on this application is true. You further agree that your electronic signature is binding on this adoption application. You understand that completing this application does not guarantee you will get this dog or any dog through our rescue. Please check the box below and fill in your name(s) to indicate that you have read, understand, and agree to all of the above.
The rest of the adoption process is a vet reference (please notify your vet we'll be calling), a home visit and meet-n-greet/in-person discussion about the dog and your family. If you rent, we also need written proof from your landlord that you are allowed to have dogs and listing any restrictions. Please check your email regularly after submitting this form as we communicate primarily via email.
Please read the above, check this box, sign, and click Submit.*

I/We have read and understand all of the above.
Applicant's Signature*
Co-Applicant's Signature
Today's Date*
Should be Empty: