Diamonds in the Ruff Adoption Application

Pet of Interest*

Adopters Name*

First NameLast Name

Adopter must be 21 to Adopt!

Please enter Adopters Date of Birth*

Date

Occupation*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number - Home*

Area CodePhone Number

Phone Number - Cellular

Area CodePhone Number

Email *

Confirm Email *

Name of other adult in household:

First NameLast Name

Relationship to you:

SpousePartnerRoommate

Do you live in a:*

Do you:*

OwnRentLive with ParentsOther

If Renting: Please indicate landlord contact information

Do you have a fenced yard?*

YesNoPartial

If fenced, please give details on height, material, # of gates, are gates locked or lockable?

Do you have a pool?*

YesNo

If you have a pool, is it fenced?

YesNo

Household Setting

RuralSuburbanUrban

Describe your Homes Activity Level

Busy/NoisyModerate Comings/GoingsQuiet with Occasional Guests

Please List all People Living in the Household (Include Name, Relationship, Gender and Age)*

Does Anyone in your Household have Allergies to Animals?

YesNo

Vet Reference

Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

Please list 2 personal references

Reference #1: Full Name*

First NameLast Name

Relation to applicant(s):*

E-mail

Phone Number*

Area CodePhone Number

Reference #2: Full Name*

First NameLast Name

Relation to applicant(s): *

E-mail

Phone Number*

Area CodePhone Number

Current Pets

1. Pets name

Type of Animal

Approximate Age

Sex

MaleFemale

Spayed / Neutered

YesNo

How / Where did you obtain this pet?

How many years have you had this pet?

2. Pets name

Type of Animal

Approximate Age

Sex

MaleFemale

Spayed / Neutered

YesNo

How / Where did you obtain this pet?

How many years have you had this pet?

3. Pets name

Type of Animal

Approximate Age

Sex

MaleFemale

Spayed / Neutered

YesNo

How / Where did you obtain this pet?

How many years have you had this pet?

If you have more than 3 pets please list all here and include above requested information!

List your Previous Pets

1. Pets name

Type of Animal

Approximate Age

Sex

MaleFemale

Spayed / Neutered

YesNo

How / Where did you obtain this pet?

How many years have you had this pet?

What happened to this pet?

2. Pets name

Type of Animal

Approximate Age

Sex

MaleFemale

Spayed / Neutered

YesNo

How / Where did you obtain this pet?

How many years have you had this pet?

What happened to this pet

Your New Pet

Who will be responsible for the care of the pet?*

What is your primary reason for Adopting a pet?*

Where would your pet sleep?*

IndoorsOutdoors

How many hours a day will your pet be left alone? *

Where would the pet be when he/she is left alone?*

IndoorsOutdoors

If outdoors where would pet be?

If other, where?

When you are at home, the pet will be?*

InsideOutsideOther

If other, where?

Which rooms or areas of your home will be off limits to the pet?*

If the pet will be outside at all, what outside space is available for the pet?*

If other, what space?

When you travel, who will care for the pet when you are gone?*

Under what circumstance would you not keep the pet?*

If other reason, why?

If the pet becomes ill or injured, are you financially prepared to provide the medical care?*

YesNo

The pet may live 15+ years, what would you do with the pet if you could no longer care for the pet?*

Is there anything else you would like to tell us about yourself?

Questionnaire Information: All of the information I have provided in this Questionnaire is true and correct. If any of the information changes, I will advise you promptly. By submitting this form and if approved to adopt, I agree to the Adoption Terms listed below.

As an adopter, I agree to the following Adoption Terms:

1. To allow a representative of TN Diamonds in the Ruff Pound Pups to visit my premises in order to insure the terms of this agreement have been kept.

2. The animal will not be kept strictly outdoors.

3. The animal will not be kept on a chain.

4. The animal will be provided with adequate fresh food and water, clean, dry shelter when outside, and daily exercise.

5. To provide a safe collar with rabies and I.D. tags to be worn at all times.

6. To obey all applicable laws governing control and custody of animals.

7. To provide all medical care and treatment needed by the animal, including but not limited to, yearly medical checkups, yearly vaccinations, and preventative heartworm and flea medication.

8. To adopt the animal only as a personal pet/companion and not as a gift, working animal or guard dog.

9. The dog is not to be sold, given away or surrendered to a shelter for any reason. If you are unable to keep the dog for any reason, you must contact Diamonds in the Ruff Pound Pups via phone at 731-446-4013 and return the dog. Failure to return the dog to Diamonds in the Ruff Pound Pups will result in a $1000 fine.