Break The Chain Pit Bull Rescue-Transport

Break The Chain Pit Bull Rescue & Transport

Applicant Information

breakthechainpitbullrescue@live.com
Name of Primary adopter:                            Birth Date:
Address:   
City:                                     State:              Zip:    
Length of time at this address:
Name of County:                                         Email:

Occupation:          

Day Phone:               Cell Phone:   Evening Phone:    

Which dog are you interested in?  1^st choice:  2^nd choice: 

What kind of temperament are you looking for? 

Is there a particular color of dog you prefer?  Age preference?  

Why do you want a Bully breed? 

References 

Please provide the contact information of a veterinarian you have used before and plan to use with your new dog.  If you haven't used a vet before which one do you plan on using with this dog? Vet references are checked.  

Vet Name:         Vet Phone:   
Vet records are under the name of:   

Please provide two references who we may contact -- do NOT list relatives. 
(Suggested references: friends, co-workers, dog trainers, etc.)  

Name:       Name: 
Phone:       Phone: 
Relationship:       Relationship: 

Please list place of employment for yourself and your spouse, if applicable:  

Your Employer:      Length of service:
Address:   
Phone:     

 
Spouse's Employer:      Length of service:
Address:   
Phone:       

Household Information 

Home:    q  Own   q Rent  Type of house; single family, townhouse, condo:  

Are you moving in the near future?   q Yes      q No  
If so, please explain: 

If you own your home, provide the home insurance carrier you use – many have breed restrictions. 

If you rent your home, you MUST provide your landlord's contact information for verification – many have breed restrictions.

Landlord Name:     Company:  
Phone:    

In addition to yourself, list below all people who currently live at this residence.

Name:      Name: 
Age:      Age: 
Relationship:     Relationship: 
  
Name:      Name: 
Age:      Age: 
Relationship:     Relationship: 
   
Does anyone in your house have any allergies to dogs?    q Yes   q  No  

List below any cats, dogs, or other animals who currently live in your household:
(use blank space to add more if necessary) 

Name:      Name: 
Breed:      Breed: 
Age:      Age: 
Gender:     Gender:
Spayed/Neutered:    Spayed/Neutered: 
Owned how long:    Owned how long: 
Kept where:     Kept where: 
  

History 

Have you owned a dog before?   q Yes   q No         A large breed?   q Yes   q No  

A large Bully breed – American Pit Bull Terrier or Staffordshire Terrier?  q Yes   q No 

If yes, please explain in detail what happened to it:  
   
If your last dog died, please state the dog's name and date deceased:  
   
Have you ever taken one of your pets to a shelter?   q Yes   q No  

If yes, please describe the circumstances:   

Fences 

Do you have a fenced area on your property?  q Yes   q No 

What type of fencing do you have?  Privacy, split rail, metal, etc. 

Is the area completely fenced?     q Yes   q No   
  
How high is the fence?     ft.     Does the fence have a lockable gate?   q Yes   q No 

Approximately how many square feet of space is fenced area (length x width):       sq. ft. 

Exercise 

If you don't have a fence, how do you plan to have your dog relieve/exercise itself?   

Do you realize even with a fence that dogs need to be leash-walked every day?

q Yes     q No      q Need more information on this

How active is your lifestyle aside from work?          Please explain:    
  
Do all adults work full time?   q Yes    q No   If no, please explain:  
  
How many hours each day will your new dog be alone?

How many hours each day will you spend time with your new dog?      
  
Where will your new dog be kept when it is alone?    

Where will your new dog sleep?      

We strongly advise using a crate with your new dog – do you agree?   q Yes   q No
Please explain:   
   

As a condition of adoption, BTCPBR expects dogs and their owners to attend an obedience training class within 90 days of adoption.   This helps bond the dog with its new owner, establishes the owner's leadership role and provides a fun learning experience for both of you.  Would you be able to do this? q Yes   q No 

If no, please explain: 
 

Are you agreeable to having a home check done prior to adoption?   q Yes   q No
If no, please explain. 
  
If you are ever unable to keep the dog, we require the dog be returned to us. 
Is this agreeable?  q Yes   qNo 
 

Donation  

BTCPBR requests a donation when adopting a dog.  Depending on the expenses 
incurred in the dog/puppy's rescue and veterinary care, this could range up to $275.00.  All animals are spayed or neutered prior to placement. 
Is this acceptable? q Yes   q No 

Please realize that dogs need regular veterinary care throughout their lives, including yearly vaccination boosters, monthly heartworm pills as well as flea and tick preventative medications. Bully breeds typically live for 10-12 years. 

If you find the donation for our dogs expensive, you need to evaluate how you can reasonably expect to afford the appropriate veterinary care each dog requires. Please seriously consider these costs before adopting.  

BTCPBR volunteers work extremely hard to ensure our dogs are healthy and up-to-date on vaccinations.  We want our dogs to continue to receive regular medical check-ups to maintain their health.  It is YOUR responsibility to pay for any medical costs your dog requires. 
Are you prepared to accept this responsibility?  q  Yes   q  No   

If yes, then please indicate by signing below. 
 


 
I confirm all information contained herein is true and accurate to the best of my knowledge and agree to conform to the aforementioned requirements of care. 
 

Name: _____________________________  Date: ______________________ 

Name: _____________________________  Date: ______________________ 

If completed via email you can sign this document when you meet the dog. 
 

Supporting breeders is not what we need to do when there are so many homeless bull breeds in the U.S.  We need to find loving, responsible homes for the many dogs that are already here and dying in shelters every day.