Even Chance Pit Bull Advocacy + Resources + Rescue Adoption Application
Your location: (required)
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Even Chance dog(s) that you are interested in:
1.
Personal Information:
Your Name
First:
Spouse/ domestic partner name:
First:
Your Address
Primary Phone Number
Secondary Phone Number
Email Address
Your Occupation
Employer Name
Employer Location
Employer Contact Number
Spouse/domestic occupation:
Spouse/domestic Employer Name
Spouse/domestic Employer Location
Spouse/domestic Employer Contact Number
Household Information:
Children or Minors in Home
Child Name/Age
Name:
Do children/minors have experience with dogs?
Yes No
What level of supervision will children/minors have with the dog?
List other family members/roommates/boarders that reside in household?
Has everyone in your household been included and agree with the decision to adopt a pit bull type dog?
Yes No
If no, please explain:
Who will be the primary caretaker for the dog?
Other Pets in Household:
Do you own other pets?
Yes No
If so, please list:
Are all pets up to date on vaccinations?
Yes No
Are all pets spayed/neutered?
Yes No
Are all pets on heartworm prevention?
Yes No
If yes, what type?
Veterinarian Name
Address
Phone number?
Please tell us about the pets you have owned in the past 10 years. Include: Pet name? Species? Breed? Age? Spayed/neutered? Temperament?
If applicable, please explain why you no longer have this/these pet(s):
Residence Information:
Type of residence: (House? Attached home, duplex or flat? Apartment? Mobile Home? Other?)
House Attached home, duplex or flat Apartment Mobile Home Other
What type of environment is your home located? (City? Suburban? Rural? Farm? Other?
Do you rent or own?
Rent:
Does your landlord or complex accept dogs?
Yes No
Are there any breed restrictions?
Landlord’s Name
Landlord’s Phone Number
Do you have renter’s insurance?
Yes No
Own:
Homeowner’s Insurance Company Name
Homeowner’s Insurance Agent Name
Homeowner’s Insurance Agent Phone Number
Does your home have a yard?
Yes No
If yes, is it fenced?
Yes No
Approximate Fence Height
Fence Type
wood/vinyl concrete/structural Wall chain-link wrought iron Electric Other
Is the fence secured with a lock?
Yes No N/A
Do you have a pool?
Yes No N/A
Is it fenced separate from the yard?
Yes No N/A
Plans for your new dog:
Please tell us what purpose the dog will serve in your life. Identify all that apply.
Companion for you/for entire family Companion for child Companion for pet Guard dog for business Guard dog for personal/home Working dog Other(please explain):
Where will dog spend most of its time?
What outdoors areas will the dog have access to?
How many hours will the dog be left alone per day?
Where will the dog spend most of its time when alone?
How do you feel about crating your dog?
Where will the dog sleep at night?
If you have other pets, how will they be managed when unsupervised?
How do you plan to exercise the dog?
What types of traits are you looking for in a dog?
Please describe your expectations regarding the dog’s behavior/training:
Are you willing and able to attend weekly training classes upon adoption?
Yes No
If behavior problems arise in the future, are you willing to hire a trainer or behaviorist?
Yes No
Current Veterinarian’s Name
Current Veterinarian’s Practice Name
Current Veterinarian’s Phone Number
If no current vet, are you willing to research prior to adoption?
Yes No
Are you familiar with emergency clinics around you area?
Yes No
If no, are you willing to research prior to adoption?
Yes No
Owning a pet is an investment in both time and money. Can you afford proper vet care, training, shelter, food, boarding, etc?
Yes No
If so, how much do you expect to spend each year for basic care?
How much do you expect to spend in an emergency?
Under what circumstances would you decide not to keep your new dog?
Moving Separation/Divorce Pregnancy or New Baby New Roommate Illness/Allergies New Carpet/Furniture Behavioral Problems Veterinary Expenses Change In Employment Other
Would you object to inspection of your premises prior to adopting?
Yes No
Please provide 3 references not related to you that we can contact to attest your character. Include full names and phone numbers.
Please provide any additional information that you would like us to know about you as a potential adopter:
How did you hear of Even Chance: Pit Bull Advocacy + Resources + Rescue?
