Adoption Application - NorthEast Pit Rescue & Sanctuary, Inc.

Personal Information

Your Full Name

Spouse's Full Name (if applicable)

Phone Number

Email Address

Number of Children in Your Home

Ages of Children

Are there any others residing in your home?

Yes

No

If yes, please list.

Employer Name

Job Title

Supervisor's Name

Employer Phone

Employer Address

Employer City

Employer State

Employer Zipcode

How long have you worked there?

Adoption Information

Home Address

City

State

Zipcode

Number of years at this address?

If less than two years, what was your previous address?

Is this where your pet will live with you?

If no, where will you and your pet live?

What type of residence is this?

Do you rent or own?

Rent

Own

If you rent, please provide your landlord's name & telephone number.

If you rent, do you have your landlord's permission to adopt a dog?

If you move, what do you plan to do with your pet?

Residential Information

What do you think makes this particular pet a good choice for you?

What experience, if any, do you have with this particular breed of dog?

Do you have a fence around your yard? If so, please describe.

How will you exercise your pet?

How many hours are you away from home during the average work day?

Where will your pet be kept during that time?

Where will your pet sleep at night?

What kind of other pets do you have at home? Please list types/ages/sexes.

Are they all current on their vaccinations?

Your Veterinarian's Name

Veterinarian's City

Veterinarian's Phone

Does anyone in the household have allergies?

Does anyone in the household have Asthma?

Have you, or anyone in your household, been convicted of animal cruelty, neglect, or abandonment?

Have you ever had to give up a pet? If so, please explain.

Is there anything else you would like to add?

References

Reference #1

Reference #2

Reference #3

Reference #1

Reference #2

Reference #3

Submit Your Application

By entering my name below and clicking "submit" I certify that all information provided on this form is true. I give permission to Rescuer to verify information as needed. I understand that a home check may be mandatory prior to adopting a pet. Any false statements made will terminate potential adoption.

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