Pulled From The Pits Adoption Application

PULLED FROM THE PITS

17 Lower Rd, Minot, Maine 04258 - info@pulledfromthepits.com
This adoption application is designed to help Pulled From The Pits 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.
Applicant Information
Name of the dog you are interested in: *
If the Dog you are applying for is not available, do you want us to contact you with other options? *

Yes No
Your full name: *
Your Date of Birth: *
Drivers License issuing State: *
Drivers License Number: *
Physical Street Address: *
City, State, Zip *
Mailing Address (if Different than Physical):

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home Phone:

Area Code Phone Number
Cell Phone: *

Area Code Phone Number
E-mail: *
Employer: *
How long have you been employed here: *
Employer Phone Number: *

Area Code Phone Number
PLEASE PROVIDE TWO REFERENCES THAT ARE NOT MEMBERS OF YOUR IMMEDIATE FAMILY:
Personal Reference 1: *
Personal Reference Phone Number: *
Relationship to you: *
Years Known: *
Personal Reference 2: *
Personal Reference Phone Number: *
Relationship to you: *
Years Known: *
ABOUT YOUR HOME
Who will be the pet's primary caregiver? *
Are all members of your household in agreement with this adoption? *

Yes No
Do you live in a(n):? *

House Apartment/Condo Townhouse
Your home is: *

Owned, by you or your spouse/life partner Owner, by someone else within the house Rented directly from the owner or through a management company rented as part of a group of roommates
If renting, is your name on the lease?

Yes No
If renting, do you have landlords permission to have a dog?

Yes No
Please provide name and phone number of landlord:
Who shares your household (check all that apply) *

I live alone Spouse/Life Partner Boyfriend/Girlfriend Roommate(s)
Are their any children in the home *

Yes No
If yes, how many?
If yes, what are their ages?
If yes, have your children been around animals before?

Yes No
If there are children, please explain their experience with dogs.
At what age do you feel children are responsible enough to care of a pet without assistance? (i.e. walk, feed, train) *
If your present relationship/living situation were to change and you were no longer able to care for the dog, a new application must be submitted and approved in order to transfer ownership. Do you understand? *

Yes No
Do you have plans to move soon? *

Yes No
If you were to move, what will you do with your dog(s)? *
Does anyone in your household have an allergy to dogs that you are aware of? *

Yes No
Is someone home during the day? *

Yes No
If yes, Who?
Where will your dog spend most of his/her day when you are home? *

Indoors Yard Kennel Indoor/Outdoor (doggy door, fenced yard) Garage Enclosed patio
How many hours a day will your dog be alone? *
Where will your dog stay when he/she is home alone? *

Loose in the house Kennel/Crate in the house Indoor/Outdoor (doggy door/fenced yard) Outside only (on a run) Outside only (loose in the yard)
When will the dog be inside? *
When will the dog be outside? *
Where will the dog sleep at night *
What rooms are off limits? (if any, please explain) *
What outside areas are available to the dog? (check all that apply) *

Front yard Backyard Enclosed patio/porch Dog house Garage Dog Run
Do you have a doggie-door? *

Yes No
Is your yard shared with your neighbor? *

Yes No
Do you have a fully fenced yard? *

Yes No
If yes, what is the height and type of fence?
Have you inspected your fence recently to ensure in good working order?

Yes No N/A
If your dog has access to a fenced yard, where is the yard located?

Front yard Back yard Side yard
If you have a fence, which of the following is used to secure your gate?

Latch Padlock Keyed lock We don't lock our gate
If your gate does not have a lock, are you willing to install one?

Yes No
Who has access to your yard? *

No one does Gardener Pool man Utility worker Postal worker Housekeeper Delivery Driver Neighbor
If someone has access to your yard, where will your dog be kept while they are working?

In the house On a run outside In the garage In a room inside In a kennel
If anyone has access to your yard, do you trust them not to let your dog get out?

Yes No
Current/Previous Pet Information
How would you describe your dog owning experience? *

I have had dogs of my own as an adult I grew up with dogs or have worked with them but have not owned them as an adult I have never had one or have limited experience with dogs
Have you owned a pit bull/bully breed before? *

Yes No
If no, what is your experience with them?
What do you appreciate about this breed? *
Are you aware of the dog-aggression issues that may be present in this breed? *

Yes No
How are you prepared to handle/address these issues should it arise? Please be specific *
How many dogs have you owned in the past 5 years? *
What happened to the other dog(s)? *
Have you ever given up a pet? *

Yes No
If yes, what were the circumstances?
Which of the following reasons might force you to give up your dog? (check all that apply) *

Excessive barking/neighbor complaints Biting/Aggression Shedding/Dirty House training problems Excessive vet bills/Chronic illness New spouse/partner doesn't like dogs Digging in the yard Not trainable Financial problems Having a baby Pets are not getting along Aggressive on leash Destructive chewing Divorce/Seperation Allergies Poor watchdog Moving/relocating Growling/nipping at guests Nips or bites at children None of the above
Do you currently have pets? *

Yes No

If yes, Please list current pet information here

Type(dog/cat)

Name

Breed

Gender

Age

Spayed or Neutered?

If No, Why?

Pet 1

Pet 2

Pet 3

Pet 4

Pet 5

Who do you use for a Veterinary Practice? *
What is their address? *
What is their phone number? *
Have you called your vet to release information to us to process our reference check? ***PLEASE NOTE: This must be done before we can process your application *

Yes No N/A
If you do not have a vet, would you like us to recommend one? *

Yes No I have a vet
How do you feel your current pet(s) will adjust to a new dog in the house?
Have you had experience with behavioral or medical issues with your previous or a current pet? *

Yes No
If yes, please explain
Why do you want to adopt a rescued pit bull/bully breed? *
Share your reasons for wanting a dog? (check all that apply) *

Family pet Companion Gift for someone Child's companion Protection/Guard dog Companion for another pet
If your dog develops behavioral problems, what will you do? (please explain) *
What type of training are you interested in doing with your new dog? *
Have you/or Would you be willing to enroll your current dog(s) in obedience classes? *

Yes No Only if I was having problems
How will you exercise your dog and how often? *
When will you allow your dog off leash? (check all that apply) *

Public park Hike Dog park Back yard Front yard Beach Neighborhood walk
If your dog got out or was lost, what would you do? *
Have you ever house-broken a dog or puppy before? *

Yes No
What method do you intend to use to house train your new dog? (check all that apply) *

Rub nose in offending spot Take out every couple of hours Crate training Consult a professional
Additional Information
What type of personality do you want your pet to have? (i.e. calm, energetic, protective, couch-potato) *
What type of food will you feed your dog? *

Dry Canned
What brand of food do you feed your dog? *
Would you like food recommendations *

Yes No
Pets are an investment of your time and money. Are you financially and emotionally able to care of your new dog at this time? (i.e. groom, medical care, proper diet, exercise, shelter and love) *

Yes No
Are you able to make a long-term commitment to care for your new dog? (life span can be 15 years or more) *

Yes No
What is your monthly budget for your dog? *
Additional comments about why you would like to adopt this dog?
Please list anything else you would like to share with us that may not be listed above.
PLEASE READ AND AGREE TO EACH STATEMENT BELOW:

By selecting the "I understand" or the "I Agree" checkbox, this is in place of an "initial" due to the form being electronic.
I understand that a home visit is required prior to final placement. *

I understand I DO NOT understand
I understand that a home visit does not guarantee placement. *

I understand I DO NOT understand
I agree to provide my own collar, leash, and personal ID tag at the time of completing the adoption contract. *

I agree I disagree
I understand; if for any reason at all, I have to give up my dog, I am to notify Pulled From The Pits to relinquish the dog back into their care immediately. *

I understand I DO NOT understand
Date *

Month Day Year
Date (Please note we will adjust this date at the time of Adoption to the finalized adoption date)
Time *

: Hour Minutes AM/PM Option
Signature

Clear
I understand that I assume full responsibility for the welfare of this pet from the date of adoption.

WE RESERVE THE RIGHT TO REFUSE ADOPTION TO ANY APPLICANT FOR ANY REASON. THIS APPLICATION BECOMES PART OF OUR BINDING CONTRACT.
Should be Empty:

PULLED FROM THE PITS

Applicant Information

ABOUT YOUR HOME

Current/Previous Pet Information

Additional Information