NWA BULLY HAVEN RESCUE
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NWA Bully Haven Rescue ADOPTION APPLICATION
WE HAVE THE RIGHT TO DENY ANY APPLICATION FOR ANY REASON!!!!!!!!!!!!!!!
MUST LIVE WITHIN 2 HOURS OF SPRINGDALE ARKANSAS TO ADOPT AS WE REQUIRE MEET AND GREETS WITH OUR RESCUES AND HOME CHECKS
FOR US TO BE ABLE TO WORK YOUR APPLICATION IN A TIMELY MANNER PLEASE FILL OUT THE APPLICATION ACCURATELY AND COMPLETELY!!!!!! YOUR APPLICATION WILL NOT BE APPROVED IF THE FOLLOWING REQUIREMENTS ARE NOT MET!!!!!!!
Interested in Adopting
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Interested in puppy
Interested in adult
Interested in senior
Morticia
Rosie
Stitch & Angel
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Indicates required field
Adopters Name
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First
Last
Phone Number
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Adopters Name
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First
Last
Phone Number
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Email
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List all family members living in your home INCLUDING YOURSELF (Name/Age/Relationship) MUST INCLUDE AGES!!!!!!!!
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Is anyone living in your home allergic to dogs?
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Yes
No
If yes, who
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You live in a
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House
Apartment
Condo
Duplex
Other
Do you
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Own (WILL VERIFY WITH COUNTY)
Rent (WILL VERIFY WITH LANDLORD)
If renting what name is the lease under? (If this doesn't apply use N/A)
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Landlords Name (If doesn't apply use N/A)
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First
Last
Do you have a fenced in yard?
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Yes
No
Landlords Phone Number
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Yard Size
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Type of fencing (chainlink, privacy, ect)
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How tall is your fencing?
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If no fence how will you exercise the dog?
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Do you lock/secure your gate/gates?
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You secure your gate/gates with what?
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Do you have a pool?
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Yes
No
Does your meter reader have to enter your yard?
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Yes
No
Does your home have a dog door?
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Yes
No
List all your PAST animal history (Name/Age/Breed/Spayed or Neutered/Reason they are no longer with you)
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List all of your CURRENT pets (Name/Age/Breed/Spayed or Neutered
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Tell us a little about your life style so that we can pair you with the right dog. (Do you jog, have a lot of social activities at your home, couch potatoes, etc.)
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Do you have a current vet?
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Yes
No
Vet Clinic Name
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Please list all previous Vet Clinics and phone numbers so that we may obtain current and previous vet records
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Under what circumstances would you chain up a dog?
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Vet Phone Number
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Under what circumstances would you give up a dog?
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Why did you choose this breed?
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Your interested in adopting
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Male
Female
Interested in adopting
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Baby
Young
Adult
Senior
Color of dog
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Purpose of Dog
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Indoor or Outdoor Dog
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Indoor
Outdoor
Where will the dog sleep in bad weather?
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When you go to work where will the dog stay?
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How much time will the dog be home alone on a daily basis?
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I am adopting this dog for?
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What kind of behavior do you find unacceptable?
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If the dog has behavior problems how will you discipline him/her?
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Do you understand that a home check where the dog will be living is required before the adoption will be approved?
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Yes
No
Are you opposed to a home visit after the adoption process is complete to verify the dog is adjusting well to your home?
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Yes
No
I understand and agree that by signing below that I fully release NWA Bully Haven Rescue from any and all liability accidents caused by the adopted dog while the adopted dog is in your home and care. This includes any pets, children, friends or guests. BY SIGNING BELOW I UNDERSTAND AND CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND ACCURATE.
*
Date
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Submit
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