Brick City Rescue, Inc Adoption Application

Brick City Rescue, Inc. Adoption Application
This questionnaire is designed to help Brick City Rescue, Inc. and yourself determine if a specific dog is the right one for you and your household. All adopting parties are required to complete this form prior to adoption. Please answer EVERY question. If a question does not apply to you, type N/A in the answer field. Your application will not be submitted until every question has been answered. Brick City Rescue, Inc. reserves the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoptions!

You MUST give permission to your veterinary office to release records to Brick City Rescue so that your application can be processed!
Applicant Information
Name of the dog you are interested in and why?*
How did you hear about us?*
Your full name:*
Instagram/Facebook Names:*
Street Address:*
City, State, Zip*
How long have you lived at your current address?*
Home Phone:

Area CodePhone Number
Work Phone:

Area CodePhone Number
Cell Phone:

Area CodePhone Number
Best time to call:
E-mail:
Employer:
Character reference (cannot be related to you)*
Character reference phone number:*
Vet reference:*
* You MUST give your vet permission to disclose your records to us!
Vet phone number:*
Vet records are under the name of:*
Household Information
Are all members of your household in agreement with this adoption?*

YesNoDon't Know
Do you live in a*

HouseApartmentCondoOther
Do you own or rent?*

OwnRent
If rent, provide name and phone number of landlord:*
Does your landlord allow dogs?*

YesNo
Are there any restrictions from your landlord or subdivision?*

Number of petsSize or weight restrictionsBreed restrictionsNone
Do you have a fully fenced yard?*

YesNo
Height and type of fence*
How many adults are in your household?*
How many children are in your household?*
If children, what are their ages?*
Does anyone in your home have allergies to dogs or have asthma?*

YesNo
Do all adults in the home work full time?*

YesNo
Where will your dog be kept during the day?*
Current/Previous Pet Information
List any pets you currently own and their ages*
How many of these pets are spayed/neutered?*
If any of your pets are not spayed/neutered please explain why here:*
List any previous pets you have owned and what happened to them*
Have you adopted from an animal welfare group before?*

YesNo
If yes, what group?*
Have you ever taken any pet to a shelter or given an animal away?*

YesNo
If yes, please explain here:*
New Pet Information
What type of personality do you want your pet to have? (i.e. calm, energetic, protective, couch-potato)*
Are there any regular visitors to your home (animal or pet) which your dog must get along with? If yes, whom? *
Are you aware of crate training?*

YesNo
Are you willing to work through your new pet's issues, if any?*

YesNo
Do you plan to take an obedience class with your dog?*

YesNoNot sure
If yes, where?
Are you familiar with positive reinforcement methods of dog training?*

YesNo
Would you like a trainer recommendation?*

YesNo
How many hours a day will your new dog be left alone?*
Where will your new dog be kept when it is left alone?*
Where will your new pet stay when you are on vacation?*
A home check is required prior to approval of application.*

Yes, I agreeNo, I disagree
An adoption fee of $400 for adult dogs is required and an adoption fee of $475 for dogs under 1 year is required.*

Yes, I agreeNo, I disagree
Electronic Signature
I hereby declare that the above statement is true to the best of my knowledge
Electronic Signature:*
I understand that I assume full responsibility for the welfare of this pet from the date of adoption. If for any reason I will have to give up this pet and/or have any conflicts, I will contact Brick City Rescue, Inc immediately to have them resolve any issues.

Brick City Rescue requests a $400 adoption fee for an adopted dog over 1 year. Under a year we request a $475 adoption fee.

Mail checks to:

Brick City Rescue, Inc.

PO Box 2431

Passaic NJ 07055
Should be Empty:

Brick City Rescue, Inc. Adoption Application

Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information

Electronic Signature