Name:       Age:       Driver's Lic. #:      
Marital Status:       Spouse's Name:       Age:      
Address:       City:       State:       Zip:      
Home Telephone:       Cell/Beeper:      
Employer:       Job Title:      
Work Telephone:       Working Hours:      
Email Address:    
Please enter an email. Otherwise your application may be accidentally filtered.  

Where did you hear of us?

      
Why are you looking to adopt, and why did you choose to adopt rather than buy from a pet store or breeder?
     

What dog or dogs are you interested in adopting?     

Is this dog for you or is it a gift for someone else?

What made you decided to adopt this particular pet over the others?
     
What do you think the average temperament of the breed you've selected to adopt is?

     
What previous experience (if any) have you had with this breed?

     
Do you live in a : (answer yes to the  most applicable answer)
 Single Family Home   Apartment/Condo  Town HomeMobile Home   Duplex

Do you Rent or Own: 

Are pets allowed:

Landlord Name:       

Telephone:      

How many adults reside in the home?       

How many children?       

Ages:  

Please describe an average weekday in your household (please include work/school arrival/departure times):

     
Your newly adopted pet's living situation: (answer yes to the  most applicable answer)
 Dog will live only indoors (except for potty)
 Dog will live indoors & outdoors
 Dog will live in garage/basement
 Dog will live outdoors only
 Dog will live outdoors only w/ a dog house/shade

Where will your newly adopted pet stay when he/she is home alone :(answer yes to the  most applicable answer)
 Loose Indoors
 Confined to one room
 Kept crated indoors
 Kept crated outdoors
 Outside loose in fenced area
 Outside loose in unfenced area
 Tied/chained outdoors

How will you exercise your dog :(answer yes to the  most applicable answer)
 Leash walks daily
 In outdoor kennel/run
 Free run of fenced yard
 Free run of unfenced yard

What do you consider to be reasonable ROUTINE Veterinary Expenses for your new pet YEARLY? (answer yes to the  most applicable answer)
 Under $50
 Under $100
 Under $200
 Under $300
 Under $400
 $400+
 I have no idea (as I've never had a pet) but would be willing to spend whatever is necessary to keep my new friend happy and healthy.

What will you do if your new pet becomes destructive?

     
Under what circumstances would you consider finding somewhere else for your pet to live?
     
What would you do if you couldn't keep your dog?
     
What behaviors would you consider unacceptable?

     
What would you do to correct the above behaviors? (answer yes to the  most applicable answer)
 Go to dog training classes
 Contact a private trainer
 Give dog away to someone else
 Contact place of adoption (our organization)

Please list any pets you have now, or have had in the past 10 years?

Name of Pet:      
Type of Pet:      
Breed:      
Sex:
How long with you?      

What happened to the pet?(answer yes to the  most applicable answer)
 Gave Away
 Ran Away
 Stolen
 Died: (explain):      
 

Name of Pet:      
Type of Pet:      
Breed:      
Sex:
How long with you?      

What happened to the pet?(answer yes to the  most applicable answer)
 Gave Away
 Ran Away
 Stolen
 Died: (explain):      
 

Name of Pet:      
Type of Pet:      
Breed:      
Sex:
How long with you?      

What happened to the pet?(answer yes to the  most applicable answer)
 Gave Away
 Ran Away
 Stolen
 Died: (explain):      
 

Name of Pet:      
Type of Pet:      
Breed:      
Sex:
How long with you?      

What happened to the pet?(answer yes to the  most applicable answer)
 Gave Away
 Ran Away
 Stolen
 Died: (explain):      
 

 
• If additional space is needed please continue in the comments section (at the end of the application).
 
REFERENCES
Please list the veterinarian that you've used in the past (if applicable). If you have used more than one vet throughout your pet-owning years, please list additional vets below as well. If you've never had a pet please list the vet that you plan to use on your newly adopted pet.

PRIMARY:
Veterinarian's Name:      
Hospital Name:      
Hospital Address:      
City:       State:       Zip:      
Telephone:      


SECONDARY:
Veterinarian's Name:      
Hospital Name:      
Hospital Address:      
City:       State:       Zip:      
Telephone:      

Did you use a Heartworm Preventative on your past pets (if applicable):

Do you use a Heartworm Preventative on your current pets (if applicable):

What Brand:       Location of Purchase:      

Are/Were your current pets vaccinations kept up to date? (answer yes to the  most applicable answer)
 Always
 Almost Always
 Sometimes
 Never

What age dog would you consider adopting? Answer yes or no
 Under 12 months
 Under 3 years
 Under 6 years
 Under 9 years
 Under 12 years
 Under 16+ years
 Any

Would you consider adopting an abused dog?

Would you consider adopting a special needs dog?

What temperament do you like your pets to have?      

I agree to return the adopted animal to adoption organization if I can no longer care for it: Agree or  Disagree

I am financially/physically able to care for the adopted animal. I understand the expenses involved in pet care and I am able and will meet these requirements: Agree or  Disagree

I'm stating that the information in the above pages is true, as typed, and that if any information is found to be false, Purebreed Rescue of South Florida will reclaim the said animal:
Agree or  Disagree

I understand that should I adopt from Purebreed Rescue of South Florida,  the adoption donation of $150-350 (on average) will be used to the care of other homeless pets in our care: Agree or  Disagree
 
 
Date:
 
 
 
Additional Comments:
     
 

If you have completed and are satisfied with your application, click "Submit". A new page will open confirming your application has been sent. Please print a copy of the confirmation page for your records.