Adoption Application

Last Name:

First Name:

Dog Interested In:

Phone #(s):

Address:

Email Address:

Check here if you wish to receive email updates from us:

City:

State:

Zip Code:

Own or Rent?
If renting, provide landlords contact information below. Note - if this is not provided your application will be denied.

Landlords Name and Phone Number:

Are there any dog breed restrictions that would prevent you from adopting?

Are you currently employed?

How long have you been employed / unemployed?

How many hours a day are you away?

Where will this pet be kept when you are not home?

What forms of exercise will your new pet get?

How many adults live at your home?

Are all the adults knowledgeable and accepting of adopting a “Pit Bull Type Dog”?

How many children live at your home and what are their ages?

Do you have any experience with the American Pit Bull Terrier breed?

If not, are you willing to go through Education and Responsible Owner courses?

Do you have any current pets?

If yes, please list their names, sex, if they are spayed/neutered.

Have you recently lost any pets?

If so, what happened?

Do you have a fenced yard?

What heartworm and flea prevention do you currently use and how often?

What forms of training/correction do you intend to or currently use with your dogs?

What are your expectations of a “rescue” dog and why did you choose to adopt?

Primary Veterinarian:

Veterinarians Phone Number:

Address:

City/State/Zip:

How long have you been taking your pets to this Vet?

Emergency Contact:

Please send all adoptions applications to Adoptions@RugazRescue.com
www.RugazRescue.com