Adoption — UnbreakaBULL Pitbull Rescue

Name *

Name

First Name

Last Name

Date of Birth *

Date of Birth

YYYY

Phone *

Phone

(###)

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Email *

Address *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Which dog are you applying for?

Number of additional adults in home? *

Name of additional adult

First Name

Last Name

Date of Birth

YYYY

Phone

(###)

###

####

Name of additional adult

First Name

Last Name

Date of birth

YYYY

Phone

(###)

###

####

How many children are in the home? *

Ages of children in the home

How many animals currently reside in the home? *

Gender

Breed

Age

Gender

Pick one

Breed

Age

Gender

Pick one

Breed

Age

Up to date on vaccinations?

Spayed/Neutered

Have your animals received formal training?

If yes, please explain training methods

Check all that apply to your resident animals

Food aggression

Toy aggression

Seperation anxiety

Leash reactivity

Please explain any of the above behaviors selected

How does your resident animal react with children?

Does your resident animal show aggression to animals or humans?

Primary Vet Name *

Primary Vet Name

First Name

Last Name

Vet Address *

Vet Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Personal Reference *

Personal Reference

First Name

Last Name

Phone *

Phone

(###)

###

####

Personal Reference *

Personal Reference

First Name

Last Name

Phone *

Phone

(###)

###

####

Personal Reference *

Personal Reference

First Name

Last Name

Phone *

Phone

(###)

###

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What is your experience with bully breeds? *

How do you envision spending quality time with the dog? *

Will you crate/kennel the dog? *

How will you train the dog to enter the crate if not already trained? *

How many hours a day will the dog be left alone? *

How will the dog be exercised? *

What behaviors are you NOT willing to work with? *

Rescue dogs sometimes have unknown behavior issues. Are you willing to work with unexpected behaviors? *

An expectation of adoption is following through with training. How will you go about training your rescue dog? *

Will you pay for private or public obedience / manners training?

If yes, please explain

Do you own or rent a home? *

Pick one

Landlord Name

First Name

Last Name

Landlord Phone

(###)

###

####

Do you have a yard? *

If your yard fenced? *

If no, are you willing to purchase a fence?

How will the dog be supervised during potty breaks? *

Homeowner or Renters Insurance Provider *

Insurance Agent Name *

Insurance Agent Name

First Name

Last Name

Does your home owners/renters insurance protect against dog bites?

Do you live in a county that has breed restriction legislation? *

The signature below affirms the intent to adopt or foster currently under ownership of UnbreakaBull *

Date *

Date

YYYY

Please fill out the adoption application completely and hit submit. We will be in touch after reviewing. Thank you