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Date
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Name:
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Spouse's name:
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Email:
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Address:
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City:
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State:
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Zip code:
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Home phone number:
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Cell phone number:
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Work phone number:
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What time is best to call?
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How long have you been at this address?
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How long do you plan to be at this address?
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Are pets allowed at your residence?
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yes
no
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Do you own or rent your residence?
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own
rent
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Is your residence a:
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If not owned.. Landlord's name:
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Landlord's telephone number:
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Do you have a swimming pool, pond (including ornamental ponds), in-ground hot tub, lake, river, or any other body of water in or near your residence?
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yes
no
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Is your residence air conditioned?
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yes
no
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Is your car air conditioned?
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yes
no
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Do you have stairs in your residence? Check all that apply:
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Yes, several flights between floors
Yes, only a few small stairs
Elevator building/no stairs
Yes, stairs to enter residence
One level with no stairs at all
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How many adults in the household?
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Children?
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Are you planning to have children within the next 5 years?
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yes
no
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Age of adults?
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Age and gender of children?
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How would you describe your lifestyle?
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Is someone home all day?
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yes
no
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If yes, who?
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During the week, from the time you leave in the morning, to the time you arrive home, how many hours are you away on an average day?
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On weekends, how many hours are you away on an average day?
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Where will the Bulldog be kept during the day?
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Where will the Bulldog be kept during the night?
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How often will the dog be left alone?
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Will the dog be an inside dog or an outside dog?
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inside
outside
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If an outside dog, what provisions will you make to ensure its health and comfort?
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Do you own any other dogs?
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yes
no
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Do you own any other dogs?
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yes
no
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If yes, are they Spay/Neutered?
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Please list breed, size, and gender of each:
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Do you own any cats?
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yes
no
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If yes, how many?
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Do you own any other animals?
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yes
no
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How many dogs have you owned in the past 5 years?
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you do not still own the dog(s), please describe what happened to it (them).Please be specific.
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Have you ever owned an English Bulldog before?
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yes
no
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Why did you choose this breed?
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Do you know what the English Bulldog was bred to do? If so, please explain.
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Which of the following special needs would you be willing to accept and handle?
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daily meds
special diet
frequent meds
housetraining
behavioral issues
epilepsy
food allergies
blind
deaf
incontinent
spina bifida
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Anything you want to share on this subject?
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We check veterinary references. Please provide this information for the dogs you have owned in the past.
Veterinary Clinic Name (please indicate a specific veterinarian's name if applicable)
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Veterinary Clinic Phone Number and Address
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Please list three personal references and their contact numbers, relationship to applicants and years acquainted. Please do not list relatives.
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Are you familiar with common bulldog health issues?
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yes
no
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Briefly tell us about the issues that you are familiar with.
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How do you plan to learn about common bulldog health issues?
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What is your viewpoint on the use of the crate/kennel?
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What is your viewpoint on dog obedience?
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How do you plan on disciplining the dog?
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What will you do if the dog is destructive while alone?
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What circumstances justify getting rid of a dog?
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What behavior do you consider unacceptable that you would be unwilling to deal with?
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What would you do if you could no longer keep the English Bulldog whether it is for unexpected illness, family expansion, etc.?
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Would you object to the requirement of going to dog obedience class with your English Bulldog?
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At what point, would you consider euthanasia?
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Have you ever had a pet euthanized?
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yes
no
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If yes, please explain:
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Is there any information about your family that would help us in deciding if a dog would be right for your home?
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If a dog is placed with you, are you able and willing to make a tax-deductible donation of $500.00 to Bullieangel Rescue to assist future bulldogs in need?
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yes
no
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I represent that the information that I have provided on this form is the truth to the best of my knowledge and belief, and hereby give permission for Bullieangel Rescue and Haven to use the above information to confirm that all information provided is the truth. This means that you give us permission to call references and veterinarian. You hereby give consent for your veterinarian to release the information in your current/past pet’s health files to us.
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Signature Waiver: I agree that by checking this box, this is the same as signing my name to a legal document.
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Bullieangel Rescue and Haven will be checking on the English Bulldog at various times and have the right to reclaim any English Bulldog if the circumstances warrant such action. Should an adopter ever have to give up the English Bulldog, it will be returned back to the Bullieangel Rescue and Haven at no charge to Bullieangel Rescue and Haven.
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Signature Waiver: I agree that by checking this box, this is the same as signing my name to a legal document.
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Rescued English Bulldogs cannot be euthanized without prior notification and consent of an authorized representative of Bullieangel Rescue and Haven unless the English Bulldog is in critical condition with no hope of survival in an extreme medical emergency
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Signature Waiver: I agree that by checking this box, this is the same as signing my name to a legal document.
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