BARC Adoption Application
Please read our adoption policy before submitting an application:
http://barcdogs.org/Adopt_Info.html

If there is not enough space to fully answer each question, please send additional responses to info@barcdogs.org.

If you are applying to adopt a specific BARC dog, please name the dog.
Your answer
Your Name *
Your answer
Name of Co-Applicant
Your answer
Address *
Your answer
City *
Your answer
Phone *
Your answer
E-Mail Address *
Your answer
Place of Employment (self) *
Your answer
How long have you been there? *
Your answer
Do you plan on changing job soon? If so, please explain. *
Your answer
Business Phone *
Your answer
Place of Employment (co-applicant)
Your answer
How long has he/she been there?
Your answer
Does he/she plan on changing jobs soon? If so, please explain.
Your answer
Business Phone (co-applicant)
Your answer
Best time to reach you. *
Your answer
Where did you hear about us? *
Your answer
List all the people who live in your home and their ages: *
Your answer
Do you live in a: *
If you rent or lease, do you have permission from your landlord to have a pet?
Landlord's Name and Telephone Number
Your answer
How long have you lived at your current address? *
Your answer
Do you plan to move within the next year? *
Required
If so, what will you do with your pet? *
Your answer
Are you aware that many insurance companies will not cover accidents involving breeds that they have deemed "dangerous", and pit bulls are listed among those. Those companies will refuse to continue coverage at the end of your term if they find out you own a pit bull; some will even drop you immediately. It is an unfair practice, but something we must consider before adopting one of our dogs out. To date only four of the major insurance companies do not discriminate based on breed: State Farm, Allstate, Farmers and USAA. If you have a different insurance carrier, we would need documentation stating they have no problem with you owning a pit bull type dog. Who is your current homeowners insurance carrier? *
Your answer
If you are not applying for a specific dog, do you have a gender preference?
Preferred age:
Indicate the energy level you are looking for in a dog. *
Please check the most important qualities you WANT in your new dog. *
Required
Why do you think a pit bull dog would be perfect for your family?
Your answer
In the eyes of a dog, what's a typical day look like in your household?
Your answer
Who will be responsible for the care and cost of your new pet? *
Your answer
What other pets do you have? Please list the type, age and activity level.
Your answer
Where do they sleep?
Your answer
Are they spayed/neutered?
If your animal(s) is/are not altered, please tell us why.
Your answer
If your other pet is a dog, is it currently on heartworm preventative?
Do you have a fenced-in yard?
If so, what kind and how high is it?
Your answer
Are you willing to reinforce/repair your fence if needed?
BARC does not advise taking pit bull dogs to dog parks. If anything negative were to happen, 9 times out of 10 it would be blamed on the pit bull (whether the dog started it or not). Therefore, if you do not have a fenced in yard, are you willing to walk your dog DAILY to make sure that he/she gets enough exercise to meet their needs? *
BARC requires a home visit prior to adoption. We want to meet the whole family, make sure the dog gets along with everyone and that the home is safe and secure. Are you willing to have one our our volunteers bring the dog by for a visit? *
Do you travel much?
If so, who will take care of your pet while you are out of town?
Your answer
Under what circumstances would you have to give up your pet? *
If you have checked behavior or other, please explain:
Your answer
How do you plan to train your dog? *
Your answer
Who will be responsible for the training of your dog? *
Your answer
How will you correct inappropriate behavior? *
Your answer
Are you willing to spend time training the dog to deal with problem behaviors such as jumping up, barking, pulling on the leash and/or separation anxiety? *
What behaviors would be difficult for you to tolerate or manage? *
Your answer
Are you considering taking your dog to a formal obedience class? *
If so, we would be happy to point you in the right direction.
If the adoption counselor believes it is necessary, are you willing to purchase a dog crate? *
If not, please explain why:
Your answer
Do you understand that your new dog will need to be checked annually for heartworms and continue preventative? *
Do you understand that your adopted dog will need periodic grooming to include: brushing coat, trimming nails, cleaning ears and teeth? *
Approximately how many hours a day will your pet be home alone? *
Your answer
Where will you keep your dog during the day when you are home? *
Your answer
Where will you keep your dog during the day when you are NOT home? *
Your answer
Are you willing to keep a collar with a tag bearing your name, address and phone number on your dog at all times? *
Are you willing to accept immediate and full responsibility for the ownership and care of your adopted dog, including all health care costs and necessary burdens and responsibilities of owning a dog? *
Please list the pets you have owned in the past five years by name, breed, years in household and reason for death or leaving. Also, for those pets listed, please provide a vet reference if different from your current vet.
Your answer
A BARC agent will be contacting the veterinarian(s) indicated on this application. Are you okay with us doing so? *
A dog can live 12 to 15+ years. Can you commit to caring for your new dog for that length of time? *
Please complete the following section if you or the co-applicant is in the military.
Current Duty Station
Your answer
How long will you be in the military?
Your answer
Do you currently live in base housing?
Your answer
How long have you been stationed here?
Your answer
How much longer will you live here?
Your answer
Do you have to complete a tour of duty overseas?
If so, where will you be stationed and when will that take place?
Your answer
What will you do with your dog if you are transferred overseas?
Your answer
Are you expecting a state-side transfer?
If so, when and where will you locate?
Your answer
What will you do with your dog if you are transferred state-side?
Your answer
Did you have pets at your last duty station
If so, where are they now?
Your answer
References: All applicants, please complete the following section:
Veterinarian's Name: If you don't currently have pets, who will you be using to care for your new dog? *
Your answer
Phone *
Your answer
Address
Your answer
Please list two references that you have known for more than two years, who do not live with you, and who can speak to your ability and commitment to providing a long-term, loving home for your new dog.
Personal Reference 1 Name *
Your answer
Address
Your answer
Daytime Phone *
Your answer
Evening Phone
Your answer
Personal Reference 2 Name *
Your answer
Address
Your answer
Daytime Phone *
Your answer
Evening Phone
Your answer
Estimate of Veterinary Costs:
Booster shots $40-60 (yearly)
Rabies $12-20 (yearly)
Office Visits $25-50
Heartworm Check $20-30 (yearly)
6 months heartworm preventative $40-45
6 months flea preventative $40-60
Emergency Vet Hospital $50-100+ per visit
Premium Dog Food $35+ per month
Boarding Charges $15-25 per day

Prices vary according to weight of dog and vet used and may have increased since this posting.

Signature:
NO GUARANTEES OR WARRANTIES OF HEALTH OR TEMPERAMENT CAN BE, OR ARE, MADE BY ADOPTER.
Adoption fees DO NOT cover the cost of caring and sheltering the animal you want to adopt. BARC agent will not be responsible for any medical care required by an animal adopted from us. You may return an animal for health reasons, but a refund on the adoption fee WILL NOT be given unless the return occurs within the first two (2) days following the adoption and your veterinarian has advised us of a medical condition identified during that two (2) day period. We hope this information doesn't discourage you from adopting from us, but reminds you that love comes with no guarantee.


*
Required
*
Required
Electronic contracts and electronic signatures are just as legal and enforceable as traditional paper contracts signed in ink. Federal legislation enacted in 2000, known as the Electronic Signatures in Global and International Commerce act (ESGICA).
Signature *
Your answer
Signature (co-applicant)
Your answer
BARC is a 100% volunteer operated rescue group . Please allow up to 48 hours for a reply. If no reply comes forth in that time, please feel free to email us at info@barcdogs.org. (Occasionally our "regular" life gets in the way of our "rescue" life and we can sometimes lose track of days!)
For BARC Admin Use
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service