Peanut S Place Bully Rescue

PEANUT’S PLACE BULLY RESCUE

Adoption Application

Please be informed, all information listed must be true and factual, if any information is proven to be false in your application. Your application will be denied, dog will be confiscated and any money received will NOT be returned. Please, confirm your application is completely filled out; applications that are submitted incomplete will be automatically discarded. Submit your application by:

E-mail to , subject line "APPLICATION SUBMISSION”

APPLICANT INFORMATION

Applicants Name:

Home Address:

City/State/Zip:

Home Telephone Number:( )

Cell Phone Number:( )

Best time to call:

E-Mail Address:

Applicants Date of Birth &Age:

Applicant DL # & State :

Spouse/Partners Name:

Spouse/Partners Date of Birth & Age:

Spouse/Partners DL # & State :

Applicant Currently Employed: Yes q No q

Employer Name:

Work Telephone #:

Spouse/Partner Employed: Yes q No q

Spouse/Partner Employer Name:

Spouse/Partners Work Telephone #:

FAMILY INFORMATION

People living in the home:

Name Age Relationship

1.

2.

3.

4.

5.

PLEASE NOTE - We request those all-family members or people residing in the home be present during the home check.

Have you (the applicant) or any of the individuals residing in the home been accused or convicted of animal neglect or abuse? Dog fighting? Human/child neglect or abuse? No q Yes q If so please explain:

Have you (the applicant) or any of the individuals residing in the home been denied an adoption from another rescue? No q Yes q If so please explain:

CURRENT PETS LIVING AT HOME

Please, list all the pets/animals living in the home where the dog will be staying:

Name Sterilized Age Breed/Type

1.

2.

3.

4.

5.

PLEASE NOTE - We request that all pets/animals be present during the home check.

HOME INFORMATION

Do you own your home? Own q Rent/Lease q If not, please provide the name of your Landlord and their telephone number.

Landlord/Renting Condition: We will adopt to people that rent on the condition that the landlord understands the following:

a.  The dog may have a potential weight of 55 to 70 pounds, or more.

b.  This dog is by its own nature protective.

c.  The dog is preferred to live indoors, with the family, as a family pet, unless any prior arrangements have been made.

d.  We receive written approval from the landlord.

If you rent/lease what do you plan to do with your adoptive dog?

Homeowners Insurance: We advise you to check with your homeowners or rental insurance prior to inquiring adopting a Pit Bull.

PLEASE NOTE - We reserve the right to ask for proof of ownership during the home check.

HOMES EXTERIOR SITUATION

Is your home? Urban q Suburban q Rural q

What type of home? Single family q Apartment q Townhouse q other q:

How large is your entire yard area?

Do you have fencing? No q Yes q If so please describe type, height, and if it is fully enclosed?

If your home is not fenced in what type of containment system do you plan to use to keep your dog on your property?

What type of shelter do you plan on providing when the dog is outside for playtime, exercise, etc.?

HOMES INTERIOR SITUATION

Where will the dog sleep? Eat? Bathe? Where will the dog be kept when you or no one else is at home?

How many hours will the dog be alone during the day? Week?

If you had to separate your adoptive dog from your current dogs/pets/animals is there a way to do so?

EXPERIENCE WITH DOGS, PETS OR OTHER ANIMALS

What breeds have you owned or worked with previously?

How have you prepared yourself training wise to handle large, dominant and stubborn breeds?

Are you prepared to handle a potentially protective dog? With the ability to bite if provoked?

What styles of training do you commonly use to train?

How are you going to handle dog aggression? High prey drives?

If you are interested in keeping your dog as a family pet, what outlets for energy and mental stimulation are you prepared to provide besides walks?

What are your plans for dog care when you must travel away from home?

HEALTH ISSUES

PPBR expects adopters to keep regular annual veterinary check ups, routine vaccinations or titer check ups, Rabies vaccine or other vaccinations as required by law, Heartworm preventative, flea and tick prevention. Will you and your family be able to keep up with these costs?

VETERINARIAN REFERENCE CHECKS

Name of Doctor/Clinic:

Telephone Number:

Address:

Is this the vet you will use with the dog you adopt? Yes q No q If not please provide the name, telephone number and the address of the vet you will be using:

PERSONAL REFERENCE CHECKS

Please provide 2 reference checks; we need to have at least one person who knows how well you deal with your own personal dogs, pets, animals that are not a family member. And only one family member can be given as a personal reference.

Person 1:

Name:

Telephone:

Best time to call:

Email Address:

Relationship:

Person 2

Name:

Telephone:

Best time to call:

Email Address:

Relationship:

DOG YOU ARE INTERESTED IN

Which Dog(s) are you interested in applying for?

What gender do you prefer in your home? ______Age range?

What personality of dog are you looking for?

What behaviors/temperament will you absolutely not tolerate?

PLEASE NOTE - Generally, we will not place a Pit Bull with the same gender due to same gender aggression within the breed. Pit bulls with general dog aggression will not be placed in homes with other dogs.

EXTRA NOTES/COMMENTS OR QUESTIONS

Application Agreement

1.  I understand that the adoption counselor’s determination and evaluation of the application and home check is final.

2.  I understand the Pit bull or dog that I am applying for will require sterilization (neutering or spaying) before it leaves the foster home.

3.  I understand there may be several phone calls where a PPBR volunteer may call my home collect to be able to speak to family members or myself (the applicant). These charges are not included in the adoption fee and are my responsibility.

4.  I understand that the adoption fee can range from $150 to $200 for pit bull type dogs, not including the costs of transportation to my home. The adoption fee depends of the dogs costs incurred during foster care. I understand there may be situations where there are additional costs associated with unusual special needs. The adoption costs will be informed in writing prior to adoption.

5.  I understand that by submitting this application I am not committing to any final costs or obligations.

6.  I understand that reference checks with my veterinarian, family members or other reference checks are required for my adoption.

7.  I understand that PPBR will do periodic vet checks to make sure that the dog I adopted will be taken to the vet regularly, and kept current on vaccinations and that health issues are addressed accordingly.

8.  I understand that I will not be submitting the only application for this particular dog and that the most suitable applicant will be chosen for the dog.

9.  I understand I must fill out a fully completed application in order for it to be considered. Part of the adoption process includes a home check, phone interview, and personal interview with my family members and the applicant.

10.  I understand that due to the number of applicants, applications that are approved may be kept on a waiting list until the appropriate dog comes along that fits my family’s needs. If I chose to adopt a dog outside of PPBR knowledge I will inform them of the adoption.

By signing this application, I certify that I am over 18 years of age and that all of the information I have provided is accurate and truthful to the best of my knowledge. I read all of the adoption application agreements and understand PPBR adoption process. I will contact PPBR by e-mail or phone if I have any further questions, comments or concerns.

Applicant

Signature Date

PPBR Volunteer

Signature Date