WeCare Rottweiler Rescue, Inc.
Adoption Application.

Response-O-Matic Form

 

 

Please answer all questions. Incomplete applications will not be processed.

Personal Information:

Name: Age:

E-Mail Address:

Spouse/Significant Other: Age:

Physical Address:

City: State: Zip:

Home Phone:


E-mail Address:

Your employer (If self employed, list name of your company):
Phone:

Spouse employer: Phone:

Number of Children: Their ages:

Does anyone in the household have Allergies? Yes No

Does anyone in the household have Asthma? Yes No

Are you planning a family? Yes No

Is everyone in your household in agreement on adopting this dog? Yes No

If no, who is not?

Why?

How long have you lived at this address?

Very Important: Is there a dog on our web page that you are interested in? Yes No

Which one?

Please indicate which best describes your current living situation:

House Condo Apartment Mobile Home

Do you? Rent Own Live with Parents

If you rent, name & phone number of Landlord.
Renters must provide landlord statement indicating that a Rottweiler may live on the premises.


If you own, do you have a home owners association? : Yes No

Are Dogs allowed? Yes No

What is the name of your home owner's or renter's insurance company? Insurance Agent's name and phone number.
Have you checked to see if the dog your applying for are allowed on your policy? Yes No

What type of environment? City Suburban Country

If less than two years, please list your previous address:


Besides your immediate family, are there others residing in your home? Yes No

Names:

Ages:

Does your home have a yard? Yes No       Is there a fence? Yes No

What type of fence and how tall?

Will gate be locked with a padlock? Yes No

Is the fence secured underground as well? Yes No

If you do not have a fence do you plan on putting one up? Yes No

If so, when and what type of fence?

Adoption Information:

Is someone home during the day? Yes No

If not, where will the dog stay while you are gone?

Where will the dog be kept most of the time? Inside Outside Other

Please specify other:


If kept outside, will you have a: Dog Run Dog House

Do you have a city or county ordinance that limits the number of dogs you are allowed to have in your home?Yes No

If yes, how many are you allowed to have?
What are your local licensing fees and requirements?

Do you own a Dog Crate? Yes No

If so, what type and size is the crate?

If you do not own a crate are you willing to buy one and "crate train" the rescue dog? Yes No

If no, please explain why?

Will you take your rescue dog to obedience class? Yes No

If you are not willing to take the rescue dog to obedience class please explain why?

Have you ever owned this breed before? Yes No

Where is the dog now?

Do you prefer a male or female? Male Female

Age range?

Why do you want a this breed?

Will this dog be used as a guard dog? Yes No

If yes, please explain.

What other activities do you plan to do with this dog?

How many years do you plan to keep the rescue dog?

Other Pet Information:

Do you have other pets? Yes No

Please list your current pets you have now, along with their name, age, sex, breed and if they are spayed or neutered.


Please list past pets you have had for the last 10 years, along with their age, sex and if they are spayed or neutered.


Have you ever had a dog killed by a car? Poisoned? Lost? Stolen?


Are your other pets current on all vaccinations? Yes No

Are your dogs on heartworm preventative? Yes No

What type?

If you do not give your dogs heartworm preventative please exlain why.

If the rescue that you want to adopt is or was heartworm positive are you willing to pay for the heartworm treatment? Yes No

Are all the dogs and or cats that you have now spayed or neutered? Yes No

If no, why not?

Veterinarian's name & address and Phone Number:

Name the animals are under at the vet's office (pet's name and owner's name)If vet's name and phone number is not provided, your application will not be processed.

If applicable, approximate date of your current pet's last office visit:

List your past pets you had owned in the past ten years and what happened to them:


Please explain how well you think your current dogs and or cats would get along with a rescue dog:


How did you hear about WeCare Rottweiler Rescue, Inc.?

List any Humane Societies, Organizations, Breed or Training Clubs you are associated with:

We will attempt to provide you with an honest evaluation of temperament on any dog we have to place. Do you realized that often times the complete history of a Rottweiler may not be known and you may encounter some behavioral problems?     Yes No

Are you willing to work with us on correcting these problems? Yes No

Please provide the name, address and phone number (please note if this is a work or home number) of three references not related to you:

Reference # 1

Reference # 2

Reference # 3

Have you applied to another Rescue or another breed Rescue to adopt a dog or cat? Yes No
If so, please list the name of Rescue.

Adopter understands his or her veterinarian will be contacted and a home visit will be required before Adoption can be approved. Yes No

Adopter understands at the time you receive or obtain the dog, you will be required to sign the Adoption Contract and you understand that the tax-deductible donation of $200.00 helps to defer WeCare Rottweiler Rescue, Inc.'s expense of medical, rehabilitating and caring for the dogs. Yes No

Adopter also understands that the rescue dog will be spayed or neutered, current on shots and on Heartworm preventative upon taking possession of the dog. Yes No

I certify that the information provided on this form is true & correct. I am also financially and physically able to care for this animal. I understand that proper food and veterinarian care can be costly and I am able to meet these requirements. Home checks are made on a random visit following or prior to adoption. If upon inspection we find that information contained in this application to be false, we retain the right to turn down or remove the animal from your premises without a refund of moneys paid.
Yes No

Signature


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Email: wecarerotti@bellsouth.net