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Rudy's Rescue Adoption Application
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Email *
Applicant/Co-Applicant Full Name *
Complete Address Street/City/State/Zip *
Contact number(s) *
Best time to reach you
How long at this address (years/months) *
Employer/Occupation
What is the name of the dog you are interested in adopting?
Describe the type of dog you are looking for (Age, weight, activity level, etc). *
List ALL family members living in the house (include relationship and ages)
What type of home do you live in: single family, town home, apartment, farm, etc? *
Do you own or rent your home? *
If you rent, please provide your landlord's name and phone number. We will verify with your landlord you are able to have a pet.
Describe your household. (Active, noisy, quiet, etc.) *
Does anyone in the family have a known allergy to dogs? *
Do you have a fenced yard?
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What type of fence and how tall?
Is everyone in your home in agreement with the decision to adopt a dog? *
Do you have a pool? *
List ALL other pets that you have. Specify type, breed, male/female and age *
Do you have livestock? *
Have you previously had a dog? How many years experience do you have owning a dog? *
Please list what dog breeds you have experience with *
Have you every surrendered a pet? If so, why? *
Have you ever had a pet euthanized? If so, why? *
Have you ever lost a pet to an accident? If so, please explain. *
Have you ever had a puppy/dog with parvovirus in your home/yard? If so, how long ago? *
Do your pets have a regular veterinarian? *
Veterinarian / Clinic Name/Address/Phone Number *
Are all of your pets up to date on vaccines? If not, why? *
Are all of your pets spayed/neutered? If not, why? *
Are your current pets on heartworm preventative or flea and tick preventative? *
Who will have financial responsibility of your new dog? *
Do you agree to keep your new dog as an indoor dog? *
Who will have primary responsibility for your new dog's daily care? *
Where will your new dog spend the day? (describe) *
Number of hours (average) that your new dog will spend alone, or in a crate. *
How do you plan on exercising your dog? *
Where will your new dog spend the night? (describe) *
When the dog goes outside, how do you plan to supervise it? *
How do you correct unwanted behavior? *
What behaviors or reasons would you think necessary to return your adopted dog?
If you are unable to take care of your dog due to sickness or death, do you have a plan for who will take your dog should something happen? What is the plan? *
Are you willing to let a representative of Rudy's Rescue do an initial home check and follow up visit by appointment? *
How did you hear about Rudy's Rescue?
Please list the Name, Address, Phone # and relationship (relative, neighbor, friend, etc) that is familiar with both you and your pets that you may have. *
Please list the Name, Address, Phone # and relationship (relative, neighbor, friend, etc) that is familiar with both you and your pets that you may have.
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