(Include both names and information if adopting as a couple)
1. * First Name:

2. * Last Name:

3. * Street Address:

4. * City:

5. * Zip Code:

6. Home Phone #

7. Work Phone #

8. * Select State or Province:

9. * E-Mail:

10. * How old are you?

11. Occupation:

12. Do you live with: Spouse/partner Roommate(s) Parents Alone

13. How many adults (21 and older) in your household?

14. How many individuals under 21 in your household?

15. What are the ages of the individuals under 21?

16. How far could you drive to pick up a dog?

17. Three references with Name:

Address:

Phone Number(s):

Years Known:

Address:

Phone Number(s):

Years Known:

Address:

Phone Number(s):

Years Known:

18. * By checking YES you agree to absolve Reunion Rescue and Animals First Rescue and all of its representatives from any liability in reference to a dog featured in this web site. YES NO


19. * By checking YES you agree that the dog will not be used in any illegal activities nor be found at any time in a municipality where Pit Bull presence is illegal.
YES NO


20. * By checking YES you agree that the dog is to be kept as a house pet. It shall not be sold for medical or experimental purpose, and it shall not be used for breeding. YES NO



21. Choice#1 (required)


22. Choice#2 (optional)


23. Choice#3 (optional)


24. Choice#4 (optional)

25. * Are you looking for a: Male Female Either

26. Do you prefer a: Puppy Adult Either

27. If you have a preference in color and weight, please describe it here:

28. Prefer dog to be: (check all that apply)

Already spayed or neutered

Not spayed or neutered

Doesn't matter

29. Additional requirements about the dog you would like to add:

30. Dog's living situation (check all that apply)

Dog will be house pet, living inside with family

Dog will live in basement or garage

Dog will live outdoors

Doghouse provided

Guard Dog for: Business Residence

Other - please specify:



31. How many hours a day will dog be home alone?


32. When home alone dog will be (check all that apply):

In a crate, wire cage, or dog pen inside

In a Kennel: Outdoor Indoor Both

Tied up outside: Cable Run With a chain

Dog will be loose: Indoor Outdoor

Other - please specify:

33. How will you exercise the dog? (check all that apply)

Leash walks every day

Will have cable or dog run in the yard

Will be free to run in fenced yard

Will have supervised access to unfenced yard

Will be free to roam around (Off leash and unsupervised in unfenced area)

Will bring to dog park (Public area where dogs can run and play together off-leash)

Other:

34. Is the home in an Urban Suburban Rural setting?

35. Yard size is: Small Medium Large Acreage No Yard

36. Is the yard enclosed by a fence? YES NO

37. If so, height, length, and type of fence:

38. Do you live in a House Apartment ?

39. Do you own the property? YES NO

40. If you are renting, please provide Landlord's name and phone number for verification:

41. Does your municipality have breed specific restrictions?

YES NO Don't know

42. If so, please describe the nature of the restrictions:

43. Do you have other DOGS? (Check all that applies)

No other dogs

One or more spayed female

One or more neutered male

One or more UNspayed female

One or more UNeutered male

44. Please specify breeds and ages of other dogs:


45. If you had other dogs in the past, please let us know their current disposition:

Still have the dog(s)

Died of old age fatal disease

Gave or sold to friends, relatives or acquaintance

Was hit by a car

Was stolen

Disappeared/Lost

46. Please specify what happened.

47. What other kind of animals do you own

48. Of all the breeds available why do you want a Pit Bull ?

49. Experience: Please relate any prior experience you have had with this breed:

50. * References: Please supply the name and phone number of your current veterinarian, or the one who saw your previous pet(s), with their title identification. If you don't have a vet, please provide the name of your employer, clergyman, or anyone not related to you who can attest to your character. Vet references are preferred.


51. Additional information you would like to provide about yourself and/or the dog you would like to adopt

We ask you to continue obedience training your new pet and consider crate training. Your animal has been sheltered and needs time to adjust to his new surroundings. A crate helps him feel secure and will insure your and your new dog a happy transition into his new life. We also ask that you not use invasive and painful training tools such as the choke chain. We suggest that you adhere to the suggested means of training under the guidance of Youngblood Harris or Bob Gutierrez.

Please consider raw feeding for the health of your new pet. lower your vaccinations, flea and heartworm meds by feeding your pet what he/she was designed to eat.

We also ask you to contact us after you have signed the adoption contract should you EVER decide for any reason to give up your pet. With respect for this breed, we would appreciate your allowing us to place the dog in the proper environment.

Thank you for saving a life and congratulations on your new adventure!













your name_______________________________________________________





date_____________________________________________________________