Rotts 'n Pups Rescue, Inc.

A 501(c)(3) Public Charity

This questionnaire must be completed by anyone interested in adopting a pet. We try to place our animals into permanent, responsible homes, while matching the pet to you and your lifestyle. NOTE: THE PROVIDING OF FALSE INFORMATION HEREIN WILL RESULT IN THE FORFEITURE OF ADOPTION FEES AND ANY ANIMALS ADOPTED.

We reserve the right to refuse an adoption based on poor or incomplete vet history.

Please fill out the application completely

If adopting a puppy:

If adopting a adult dog:

I authorize a representaive of Rotts 'n Pups Rescue to contact the veterinarian office named above to confirm the medical records/history of my pets.

Name of dog you are applying for:
Full Name:
Street Address:
City:
State:
Zip Code:
How long have you lived at the above address?
Home Phone:
Cell Phone:
Email Address:
Are you looking for an adult dog or puppy?
- Adult
- Puppy
Please describe why you would like a new dog in your family
Are you and/or your spouse currently employed?
- Yes
- No
Are you 18 years of age or older?
- Yes
- No
Do you live with your parents or other relatives?
- Yes
- No
Are you interested in adopting for....
- Yourself
- Family
- Someone else
Do you live in a...
- House
- Apartment
- Condo
- Mobile home
- Duplex
- Townhouse
Do you own your home?
- Yes
- No
Do you rent?
- Yes
- No
If yes, does your lease allow pets?
- Yes
- No
If you live in a rental home, apartment, townhouse or condo, please list your landlord/complex/management company name, address, and phone number.
How many people live in your household?
Do all the members of your household know that you plan to adopt a pet?
- Yes
- No
What ages are the children in your household?
Does any member of your household have alleries?
- Yes
- No
Will an adult be home during the day?
- Yes
- No
Who will be responsible for taking care of your pet?
What procedures will you use for housebreaking?
How will you handle chewing or destructive behavior?
How will you handle any behavioral issues that may arise?
What kind of exercise will your dog get?
Have you ever adopted from a humane society, shelter, or rescue? If so, who?
How many cats and/or dogs have you owned in the past 5 years?
Where are these pets now?(be specific)
Have you ever had to give up any of your pets? If so, why?
Has a dog died on your premises of distemper, parvo, or unknown causes in the past 12 months?
- Yes
- No
Why do you want to adopt this particular pet?
Do you currently have any pets? If so, please list their name(s), age(s), sex, and breed.
Do your pets live...
- Indoors
- Outdoors
Are your pet(s) up to date on vaccinations?
- Yes
- No
Are they all spayed or neutered?
- Yes
- No
Are your current pet(s) currently on flea/tick preventative?
- Yes
- No
If yes, which flea and tick preventative are your pet(s) on?
Are your dog(s) on heartworm preventative?
- Yes
- No
If yes, which one?
What is the name of your veterinary clinic?
What is their phone number?
Are you willing to go to the expense and trouble of taking your new pet to a veterinarian for full preventative healthcare at least once a year?
- Yes
- No
Will your new pet live...
- Indoors
- Outdoors
Where will your new pet sleep?
Is there a yard available?
- Yes
- No
If yes, is it completetly fenced in?
- Yes
- No
How tall is the fence?
What type of fencing?
What will you do with your pet if you go on vacation?
If you have to move what will you do with your pet?
A home visit is required. Do you agree to having an authorized representative inspect your home?
- Yes
- No
Do you agree with the above statement?
- Yes
- No
Submit Application

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Rotts 'N Pups Rescue

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