Adoption/Volunteer Application

Please provide the following contact information:

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
E-mail

Age of Applicant

Age

Spouse/Significant Other:

Name
Age

Number of hours worked daily:

0 8 or less More than 8

Number of Children Living in the home?

Besides yourself/spouse and children, how many others living in the home ?

Ages of Children/Others:

Age

Does anyone in your home have allergies/asthma:

Yes
No

Do you:

Rent
Own

Type of Residence:

House
Condo
Apartment
Mobile Home
Other

If you rent, Name and Telephone number of Landlord.

If you own, name of insurance company and agents name and telephone number.

How long at this address?

Fenced yard?:

Yes
No

Type, height of fence?

If fenced yard, is gate padlocked?

Yes
No

If no fence are you prepared to walk your dog 3 or more times a day?

Yes
No

Do you have a pool?

Yes
No

If yes, is the pool fenced?

Yes
No

How many pets does your city allow you to have ?

Name of dog you are interested in adopting?

Have you owned a Rottweiler in the past?

Yes
No

Prefer:

Male
Female
Either

Age range preferred. Select any of the following options that apply:

Puppy
Adolescent
Young Adult
Adult
Senior

Will you accept a dog with special needs?

Yes
No

Where will dog live?

Inside
Outside
Both

Where will dog sleep?

Inside
Outside

Will dog serve as a guard dog?

Yes
No

How many hours per day will dog be alone?

Do you own a crate?

Yes
No

If no, will you purchase one?

Yes
No

Will you enroll in obedience class:

Yes
No

Select any of the following options that you are prepared to deal with:

Chewing
Housebreaking
Barking/Whining
Nipping/Mouthing
Food Aggression
Digging
Jumping on People
Resource Guarding

Dogs take time to adjust to new surroundings and some behavioral issues might occur. Are you willing to work to correct these issues?

Yes
No

Do you own any other pets?

Yes
No

Breed, ages, spay/neuter status of other pets?

Reference One:

Name
Work Phone
Home Phone

Reference Two:

Name
Work Phone
Home Phone

Reference Three:

Name
Work Phone
Home Phone

Veterinarian Information

Name
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone

If you do not currently have a veterinarian please provide a fourth reference.

Name
Work Phone
Home Phone

By typing my name and dating this form below, I certify that the above information is true and I understand that prior to being approved for adoption that all information will be verified. I understand that a homevisit is required and that all members of my household must be present. I further certify that I am physically and financially able to care for a Rottweiler.

Additional comments.