Adoption Application – Queen City Pitties

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Work Phone

Cell Phone*

Email*

Enter Email Confirm Email

How old are you?*

What is your occupation?*

How many adults 21 and over live in your home? Who are they in relation to you?*

How many individuals under the age of 21 live in your home? What are their ages?*

Do all members of your household want to adopt a dog?*

Do any members of your family suffer from allergies? If so, please explain.*

Which dog are you interested in adopting?*

Please describe what the dog's living situation will be?*

How many hours a day will he/she be home alone?*

Where will the dog be kept when you are not at home? (Example: crate, pen, outside kennel, free roam in house, gated off area/room)*

How will you exercise the dog?*

Where will the dog sleep at night?*

What type of setting is your home in?*

What type of home do you live in?*

Do you own or rent your home?*

If you rent, has your landlord given approval to have a dog?*

If you rent, please provide your landlord's name and contact information.*

Have you checked to make sure your homeowner's insurance allows bully breeds on your policy? (We will need to see proof.)*

What is the size of your yard?*

Is your yard fenced?*

What type of fence?*

Do you have other dogs in your home? If so, please provide the breed, gender, age, spayed/neutered, and if shots are up to date.*

If you have had other dogs in the past, please let us know their current whereabouts and details. (Example: I still have, died of old age/sickness, given away, hit by a car, disappeared/lost, turned in to the shelter)*

Do you have any other animals in your home? If so please list.*

Who will be the main caregiver?*

How would you address undesirable behaviors?*

What are your thoughts and views on training?*

Are you willing to take the dog to training?*

What types of behaviors do you consider Unacceptable?*

Have you ever given up a pet? If so, please explain?*

What circumstances, in your opinion, justify re-homing your pet?*

Why are you considering this specific breed of dog or this organization?*

Please list the name and phone number for your current veterinarian. Please also give QCP permission to speak to your vet.*

Please list TWO references with contact numbers that are not family members.*

Remembering that pets are an investment or your time and money, can you afford to provide medical care, grooming, proper diet, proper shelter, training and exercise for your dog?*

Do you have applications in with other rescues?*

How did you hear about QCP?*

Is there any other information that you'd like us to know about you?*

I certify that the information entered on this application is true.*

Enter your name and date.

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