1.
Employer
(Primary):
2.
Occupation:
3.
Average
hours worked weekly:
4.
Number of
adults living in household:
5.
Hours adults
are home daily (including yourself):
6.
Number of
children living in your household:
Ages:
7.
What type of
area do you live in?
8.
What type of housing:
Apt.
Condo
Duplex
House
Other
(please explain, how
long you have lived here, etc.)
9.
If you
rent or lease, do you have permission from your landlord
to own a dog?
(Name and Phone number
of your landlord)
If less
than two years, please list your previous address:
10.
What breed
of dog have you previously owned and what happened to
them?
Were they spayed/neutered?
(both as appropriate)
11.
Is everyone
in your household in agreement on adopting a rottweiler?
Yes
No
12.
Other pets
in the household -- breed, age, spayed/neutered, up to
date in vaccinations:
13.
What do you know about the Rottweiler as
a breed?
14.
Why do you
want a Rottweiler?
15.
How did you
hear about us, and/or who referred you to us?
16.
What other
organizations/individuals have you applied with?
17.
Do you have
a preference as to what sex the rottweiler is?
18.
Do you have
a fenced yard?
If Not fenced, where will this rottweiler
be exercised and allowed to eliminate?
19.
What member
of the family will be taking the MAJOR responsibility
for raising and taking care of this rottweiler?
20.
What are
your plans for this rottweiler?
21.
Will you
take your rottweiler to an obedience class?
( If
you arenot willing to take the rottweiler to obedience
class please explain
22.
Do you have
a homeowners or renters insurance policy?
Name of
Homeowners or Renters Insurance Policy Carrier
23.
Do you have
a city or county ordinance that limits the number of
dogs you are allowed to have in your home?
24.
Will the
rottweiler live inside the home?
25.
Where
EXACTLY will the rottweiler sleep at night and be kept
when there is no one at home?
26.
Have you
ever used a crate before?
27.
What are the
major activities, hobbies, or exercises you and your
family participate in most?
28.
Please list
your veterinarian's name/address/phone number.
29.
What
is your estimate of cost for your dog during a year?
(ex., vet expense,
food, toys, training, etc.)
30.
Please list names,
addresses and phone numbers of three personal references
that have known you for at least two years:
31.
Are
you currently or previously involved with any dog clubs,
Humane Societies, etc.?
32.
Where
exactly do your dogs live?
33.
How long do
you plan to keep this rottweiler?
34.
What, if
any, health problems have your previous dogs had?
35.
What kind of
food ( Brand Name) do you feed or plan to feed?
36.
Who have you
adopted/purchased a rottweiler in the past? List
all:
37.
We will
attempt to provide you with an honest evaluation of
temperament on
38.
Are you
willing to work with us on correcting these problems?
39.
You as the
Adopter also understand that there is an adoption
contract and
40.
Any
additional comments you may have:
41.
I certify
that the information provided on this form is true &
correct. I am also financially and physically able to
care for this animal. I understand that proper food and
veterinarian care can be costly and I am able to meet
these requirements. Home checks are made on a random
basis following or prior to adoption. If upon inspection
we find that information contained in this application
to be false, we retain the right to turn down or remove
the animal from your premises without a refund of moneys
paid.
Electronic E-Signature
