First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Work Phone
x

Cell Phone

Alt Email

Date of Birth*

How long have you lived at this address? *

How did you hear about Pibbles 4 H.O.P.E.?*

Have you adopted or applied to adopt from Pibbles 4 H.O.P.E. in the past? If so, when? *

Describe the style of your home. *
Choose one: Single Family Townhouse Duplex Apartment Condominium Mobile Home Military Housing

Do You Own or Rent your home? *
Choose one: Own Rent

Do you intend to move in the near future? *
Choose one: Yes No

If so, please provide more information*

Please provide the name of the home or renters insurance carrier you use – many have breed restrictions *

RENTERS: Many lease agreements contain breed or weight restrictions for dogs. Have you confirmed that you are permitted to have a pit bull in your rental unit? *
Choose one: Yes No Does not Apply

RENTERS: Have you received written approval from your landlord to have an animal in your rental unit? You may be asked to provide this document *
Choose one: Yes No Does not Apply

RENTERS: Please enter your LANDLORD'S NAME and PHONE NUMBER. Your landlord will be contacted prior to any dog being placed in your home*

In which Animal are you interested in?
Choose an animal: Riley

What traits in this particular dog appeal to you?*

If you are not interested in a particular dog at this time please indicate which AGE GROUP and TEMPERAMENT that you feel would best accommodate your family's lifestyle. Please give at least 3 characteristics that you are looking for in your next dog:*

If you are looking to adopt a puppy (one year or younger), do you feel that you have a schedule that can accommodate their needs? Puppies need exercise as an outlet for their high energy levels. *
Choose one: Yes No Does not Apply

How many adults (18 years and older) reside in the household and/or will have regular direct contact with the adopted dog? *

Please list full names (including middle initials) of ALL adults living in the home:*

What is your relationship with the other adult(s) in the household? (i.e. sibling... roommate... spouse...etc.)*

Do any children (18 and under) live in the home? If so, what are their ages?*

Do any children (18 and under) frequently visit the home? If so, what are their ages?*

Who in the household will care for the pet? List all names of caregivers*

Does anyone in your home have allergies to dogs? *
Choose one: Yes No Does not Apply

Why do you want to adopt a bully breed?*

Have you done any research on dog ownership, specifically bully breeds, to make sure you are choosing the right breed for your lifestyle? Are you confident that you can handle their training, exercise and socialization needs?*

Have you ever owned or spent time with a large Bully breed – American Pit Bull Terrier or Staffordshire Terrier? If not, why do you feel an APBT or Staffordshire Terrier is an appropriate dog for your family and lifestyle?*

How many animals live in your home or visit frequently?*
Choose one: 1 2 3 4 5 6 7 8 9 10

List the NAME, GENDER, AGE, SPECIES/BREED, and LENGTH OF TIME you've had each of these animals, (e.g. "Ranger, male, age 5, DSH cat, owned 2 years")*

We believe in proper dog introductions when adopting to families who already have dogs in the home. Are you able and willing to take the time to meet with a volunteer to do this as part of the adoption process?*
Choose one: Yes No Does not Apply

List the NAMES of any other pets that you've had in the past 10 years. What happened to each of these pets*

Is your yard fenced?*
Choose one: Yes No

What type of fence is there currently?*

What is the height of the fence *

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?*
Choose one: Yes No

How do you plan to exercise your dog? Please explain the daily routine the dog will have:*

How much time will the animal spend alone during the day?*

Pibbles 4 HOPE requires that dogs under 1 year of age attend daycare to ensure they are properly socialized. If the dog that you are interested in adopting is under the age of 1 year, what program would you use for daycare ? Please provide name and phone number for daycare program.*
Choose one: Yes No Does not Apply

Please provide the name and contact information for the Doggy Daycare Location you plan to use.

Will the animal be kept inside or outside?*
Choose one: Inside Outside Inside and Outside

Where will the animal be kept when you are not home?*

We strongly advise using a crate with your new dog – do you agree? *
Choose one: Yes No

Do you have a crate to use with your new adoptive dog?*
Choose one: Yes No

Where will the animal be kept when you are home?*

Where will the animal sleep?*

How active is your lifestyle aside from work?*

Have you ever taken one of your pets to a shelter? If yes, please describe the circumstances:*

Please provide the NAME and CONTACT INFORMATION for your current or previous veterinarian. If you haven’t used a vet before, which one do you plan on using with this dog, if a vet visit is needed *

PERSONAL REFERENCE #1: Please provide the NAME/ RELATIONSHIP/ PHONE # for a personal reference-- do NOT list relatives. (Suggested references: friend, co-worker, dog trainer, etc.) *

PERSONAL REFERENCE #2: Please provide a second personal reference (NAME/ RELATIONSHIP/ PHONE #)*

Please list place of employment for yourself including the phone number, length of time at the job, and address:*

Please list place of employment for your spouse or significant other including the phone number, length of time at the job, and address: *

Pibbles 4 HOPE requires that newly adopted dogs and their owners complete an obedience training class within 90 days of adoption. Is this condition agreeable? *
Choose one: Yes No

If you are ever unable to keep the dog, we require the dog be returned to us. Is this agreeable? *
Choose one: Yes No

We expect all adopters to continue with vaccinations, preventatives and regular medical check-ups to maintain their dog's health. It will be YOUR financial responsibility to pay for any care that your dog requires. Are you prepared to accept this responsibility? *
Choose one: Yes No

Pibbles 4 HOPE requires an adoption fee when adopting a dog, this is based on the age of the dog. All animals are altered, vaccinated and micro-chipped prior to placement. Is this agreeable?*
Choose one: Yes No

A home visit is required before any dog is placed in your home. Is this agreeable?*
Choose one: Yes No

I certify that the information entered on this applicant is true. Enter your name and date*