| Date of Birth: |
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| First Name: |
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| Last Name: |
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| Address Street 1: |
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| Address Street 2: |
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| City: |
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| Zip Code: |
(5 digits) |
| State: |
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| Daytime Phone: |
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| Evening Phone: |
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| Email: |
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By Answering yes,
you agree
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| 1. to absolve Angel4CauseRescue and all of its representatives from any liability in reference to a dog adopted using this service: |
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| 2. that your dog will not be used in any illegal activities nor be found at any time in a municipality where pitbulls are illegal: |
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| 3. that your dog will be kept as a house pet. It will not be used for medical or experimental purposes, and it shall not be used for breeding: |
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| 4. to learn your local and state leash laws,and to obey those laws: |
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| 5. Occupation: |
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| Name the dog that you are interested in: |
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| Do you prefer Male or Female?: |
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| Do you prefer a puppy or an adult dog?: |
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If you're looking for a guard dog, what is it intended for?:
Business - Residence- N/A
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| Is your a home a house or an apartment?: |
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| Do you own the property?: |
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| If you rent, do you have your landlords permission to keep a pitbull?: |
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| Please provide your landlords name and phone number for verification: |
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| In the past 5 years, how many times have you moved?: |
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| Where will your dog live? INDOORS -BASEMENT -GARAGE -OUTDOORS - OTHER: |
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| How many hours a day will your dog be home alone?: |
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| Where will your dog be when you are not home? INDOORS LOOSE - INDOORS CRATED - OUTDOORS ON RUN - OUTDOORS IN FENCED YARD - OUTDOOR KENNEL: |
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| Will you provide a dog walker if your dog is home more than 6 hours?: |
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| How will you exercise your dog (please write all that apply)? WALKS - FREE RUN/FENCED IN YARD - VISIT TO DOG PARK - DOG RUN - FREE RUN/UNFENCED YARD (SUPERVISED) FREE RUN: |
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| What is your yard size?: |
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| Is the yard enclosed by a fence?: |
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| Type & size of your fence?: |
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| How many adults (21 or older) are in your household?: |
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| How many children under 21 are in your household?: |
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| What are the ages of all children under 21?: |
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| Does everyone in the home share your desire to adopt a dog?: |
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| Who will be responsible for the dogs daily care and expenses?: |
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| Do you have any other dogs?: |
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| If you do have any other dogs please provide the information: DOGS NAME - GENDER - BREED - AGE- SPAYED/NEUTERED: |
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| If you have had other dogs in the past, where are they now?: |
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| What other kinds of animals do you own?: |
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| Have you ever owned a pitbull before? If no, what is your experience with this breed?: |
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| Of all the breeds available, why do you want a pitbull?: |
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| Have you ever had a pet impounded by animal control? If yes, please explain: |
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| Have you ever been convicted of any crime relating to animals, if yes please explain: |
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| Would you return a dog to Angel4CauseRescue for any of the following reasons ( please list all that applies) A MOVE - MARRIAGE/DIVORCE - JOB CHANGE - ALLERGIES - HAVING A BABY - DOG ISN'T HOUSE BROKEN - DOG IS BADLY BEHAVED - DOG DEVELOPES MEDICAL PROBLEMS - DOG BECOMES TO EXPENSIVE: |
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| Where will you be taking your dog to training classes?: |
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| Do you have a veterinarian? If yes, please provide name and phone number: |
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| Please supply the name and phone number of your employer, clergyman, or someone not related to you who can attest to your character: |
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| Owning a dog means paying for its food, toys, veterinary care, immunizations, and more. Are you ready to pay these expenses for the dogs entire life?: |
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| Your Signature & Date: |
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