Ruff Life Dog Rescue of Illowa

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ADOPTION APPLICATION40 Questions
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Name of the Dog you Wish to Adopt* This field is required.
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Your Name* This field is required.
First Name
Last Name
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Phone Number* This field is required.
Area Code
Phone Number
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Email* This field is required.
example@example.com
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Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Country
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What type of home is this (single family, apartment, etc) and how long have you lived at this address?* This field is required.
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Do you own this home or do you rent it?* This field is required.
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Do you have a fenced in yard? If so, describe the fencing height and type.* This field is required.
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Occupation and yearly income of all household members who will financially support the care of this dog.* This field is required.
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Your age* This field is required.
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Does everyone living in your home agree on adopting a dog?* This field is required.
Yes
No
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Do you have adequate time to care for a dog, including walks, training, and exercise?* This field is required.
Yes
No
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Does anyone in your home have an allergy to dogs?* This field is required.
Yes
No
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Name of other adult living in homeType N/A in BOTH fields if there are no other adults living in your home
First Name
Last Name
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Name of other adult living in homeType N/A in BOTH fields if there are no other adults living in your home
First Name
Last Name
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First names and ages of children living in the home* This field is required.
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Please list every pet currently living in your home. Please include species, breed, sex, age, and whether they are spayed/neutered.* This field is required.
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Please list every animal that has lived in your home in the past 5 years. Please include species, breed, sex, age, and current status. You do not have to list pets that are listed under current pets. If you saw a different veterinarian than the one you currently use for any pet listed here, please provide the name and phone number of the veterinarian.* This field is required.
Huge
Large
Normal
Small
Ok
Ok
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Are all of your current pets up to date with vaccinations required by law? If no, please explain.* This field is required.
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Large
Normal
Small
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Ok
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Have you ever surrendered a pet? If so, Why?* This field is required.
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Have you ever euthanized a pet? If so, Why?* This field is required.
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Have you ever lost a pet due to an accident? If so describe what happened.* This field is required.
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Have you ever received any pet-related citation or been fined for violating any pet-related law? If yes, please explain.* This field is required.
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Large
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Small
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Ok
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How do you discipline your pets?* This field is required.
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Do you have a regular veterinarian? If so, list the name of the veterinary clinic, address, and phone number (note that we will be checking for dogs and cats to be up to date on recommended vaccinations, be spayed or neutered, and receive regular veterinary care, such as heartworm and flea preventatives).* This field is required.
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Why do you want to adopt a dog?* This field is required.
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What are you looking for in a companion dog?* This field is required.
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What interests you about this particular dog?* This field is required.
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Who will be the primary caretaker of this dog?* This field is required.
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Who will have financial responsibility for this dog?* This field is required.
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How long will this dog spend time alone & where will they stay when you are gone?* This field is required.
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Where will the dog sleep at night?* This field is required.
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Are you willing to provide regular veterinary care for this dog* This field is required.
Yes
No
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Do you agree to keep this dog as an indoor companion?* This field is required.
Yes
No
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Are you willing to have a representative of Ruff Life Dog Rescue of Illowa visit your home for a home check?* This field is required.
Yes
No
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Name, phone number, and relationship of personal reference #1* This field is required.
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Name, phone number, and relationship of personal reference #2* This field is required.
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Name, phone number, and relationship of personal reference #3* This field is required.
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Name and phone number of Landlord (if applicable)* This field is required.
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By signing this application I agree: 1) All of the information I have given is true and complete. 2) My companion dog will reside in my home as an indoor pet. 3) I will provide my companion dog with quality dog food, fresh water, indoor shelter, affection, annual physical examination and vaccinations and other veterinary care necessary, under the supervision of a licensed Veterinarian. 4) If for any reason I am unable to keep my companion pet, I agree to return him/her toRLDRoI. 5) By providing landlord information, I agree to inform my landlord (if renting) of my intent to adopt a companion dog, and agree to allow RLDRoI to contact my landlord to verify. 6) I agree to inform my licensed Veterinarian of my intent to adopt a companion dog and authorize RLDRoI to call my Vet and release information related to all animals that I have previously and currently owned. 7) I and no member of my household has been convicted of any animal cruelty offense.* This field is required.Use your mouse or track pad to sign on the line below
Clear
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How did you hear about Ruff Life Dog Rescue of Illowa?* This field is required.
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