For questions or comments about the Bark Ark Bully Rescue's application please send an email.
Which dog are you interested in adopting Required
A Second Choice A Third
Searching for Male Female Either | Adult Puppy Either
First Name Last Name
Your e-mail address
Telephone Cellphone
Mailing Address
Street Address
City State Ohio Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Massachusetts Maryland Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip
Date of Birth
What is the best time to contact you? (check all that apply) In the morning (9:00am - 12:00 noon) Early afternoon (12:00pm - 5:00pm) In the evening (5:00pm - 9:00pm) Anytime between 9:00am - 9:00pm.
Information about your Spouse / Significant Other
Name - First Last Occupation
Your occupation
Number of persons in household Adults 0 1 2 3 4 5 6 7 8 9 10 Children 0 1 2 3 4 5 6 7 8 9 10
Ages of children
List at least 2 personal references (name and telephone number of two non-family members)
Which best describes your home Other Condominium Apartment Mobile Home Town House Co-Op Multi-Family Home Patio Home Single Family Home
If Other, please describe
Is your home rented? No Yes
If rented please list your landlord and contact information (phone / address)
Fenced Yard - Play & Exercise Area
What type of fencing - containment do you have none Post & Rail Wood Privacy Picket Chain Link Vinyl Privacy Electric Wire Stake Out Dog Run / Tie Out
Height of fencing no fence / not applicable three feet or less four feet five feet six feet more than six feet Length of fencing no fence 10 feet or less 11 to 15 feet 16 to 20 feet 21 to 40 feet 41 to 60 feet more than 60 feet Width of fencing no fence 10 feet or less 11 to 15 feet 16 to 20 feet 21 to 40 feet 41 to 60 feet more than 60 feet
How long have you lived at this address less than 1 1 2 3 4 5 6 7 8 9 10 over 10 year(s).
Does your municipality have breed specific restrictions ? Yes No Not Sure
If so, please describe the nature of the restrictions
Many homeowner's insurance companies have breed blacklists which include, but are not limited to, pit bulls, American Pit Bull Terriers, American Staffordshire Terriers, Staffordshire Bull Terriers, Rottweilers, Dobermans, Akitas, American Bulldogs, Chows and wolf-hybrids and will not insure you if they reside in your home or may cancel your insurance if you add a dog of these breeds to your home.
Please check your homeowner's insurance policy regarding breed discrimination BEFORE adopting a pit bull type dog. Landlords may also have these same breed restrictions due to their insurance policies.
Please list all veterinarians used and all pets owned in the last 3 years.
Primary Veterinarian Reference(s)
Veterinarian Name Veterinarian Hospital Name Address Telephone City State Ohio Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Massachusetts Maryland Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip
Name and telephone number for all other veterinarians used in the last 3 years
List all pets owned in the last 3 years
Total number of pets owned in the last 3 years none 1 2 3 4 5 6 7 8 9 10 + Required
Pet Number One
This pet is a Dog Cat Other Breed Gender Male Female
Name Age less than 1 1 2 3 4 5 6 7 8 9 10 + year(s)
How long has (or did) this pet live with you? 0 less than 1 1 2 3 4 5 6 7 8 9 10 + years.
Where is the pet now home yard pound gave away deceased unknown
Is this pet
spayed or neutered? Yes No
up-to-date on all shots? Yes No
on monthly heartworm preventive? Yes No
Pet Number Two
Pet Number Three
If more than 3 please list the same information for the others:
How and where do you exercise your pets?
How many hours would the dog be alone on a typical day? 18+ hours 12 - 18 hours 9 - 12 hours 4 - 8 hours 1 - 4 hours 0 - 1 hour
Where will you keep the dog during the day? Outside in lot Yard Kennel Garage House At night? Outside in lot Yard Kennel Garage House
Why are you looking for an dog? (check all that apply)
Protection Breeding Purposes The Kids A Companion
Guard Dog Obedience Work Other A Gift
Why you are interested in this dog?
Are you prepared to give your adoptive dog at least a month to acclimate to the new home? Yes No
Have you ever given a pet away or re-homed a pet? If so, how and why?
Who will care for your pet(s) if you are away for any reason - vacation, emergency, other?
Is there anything else you would like for us to know?
Please review these important requirements, if you are unable to accept these terms your application can not be accepted.
Yes No In the event that you can not keep your dog are you willing to return it to Bark Ark Bully Rescue.
Yes No You agree to absolve Bark Ark Bully Rescue and all of its representatives from any liability in reference to a dog featured in this web site.
Yes No You agree that the dog will not be used in any illegal activities nor be found at any time in a municipality where Pit Bull presence is illegal.
Yes No You agree that the dog is to be kept as a house pet. It shall not be sold for medical or experimental purpose, and it shall not be used for breeding.
Yes No You understand that we do not ship any dogs - for any reason. You MUST come to Cincinnati, OH to pick up your pet.
Items marked as ' Required ' are just that - required, the form will not submit without answering these items.
Thank you for your time and interest in our special orphaned dogs. We will be back in touch after we review your application. Please contact us if you do not receive a notification within 72 hours.
Your electronic signature authorized Bark Ark Bully Rescue to contact your references and verify the information you provided in your application. If your application is approved, this document will become part of your adoption contract. Any misrepresentations in this application discovered after the adoption of a dog from Bark Ark Bully Rescue will result in the immediate surrender of the dog with no compensation due to the adopter.
Please realize an incomplete application or inaccurate information on the adoption application will result in your application being denied.
Designed by Dexter Dog Designs.