Heres what I have so far, the bulk from
http://www.outofthepits.org/AdoptionForm.html - tweaked a bit.
What do you think?
We always have an adoption agreement thats signed by the adoptee & I, for legal reasons but thats the same in each case.
We're happy that you are interested in adopting our American Pit Bull Terrier, and we want to provide you with a dog that is well matched to your situation. Understandably, we also want to provide her with the very best home possible. To that end, we have compiled a detailed questionnaire to help us with our endeavor. Yes, it is long, and will take some time to complete. We hope that you think its well worth the effort. Please answer every question. If any of the questions are left unanswered the application may not be accepted.
Please complete the following information:
First Name: Last Name
Street Address:
City: State: Zip code:
What is your home telephone number ( ) - _____-________
What is your work telephone number ( ) - _____-________
What is your mobile telephone number ( ) - _____-________
E-mail address: ______________________
Please circle the following answer that best fits, feel free to elaborate!
At present I am: Employed full time Employed part time
Unemployed Retired Student
Do you have a fenced in yard? YES NO
Do you have a kennel area? YES NO
How high is your fence? Less than 4ft. 4ft 6ft 8ft or higher
Do you own or rent your home? OWN RENT
___________________________________________
Answer the following ONLY if you rent!
Does your landlord allow dogs? YES NO
Does your landlord ban any breeds of dogs? YES NO
If yes please explain, ________________________________________________________________________________________________________________________________
Please provide the name and phone contact information for your landlord.
Name: ___________________________________________
( ) - _____-_________ [ ] Home [ ] Mobile [ ] Work
This is ONLY used to verify it is safe and legal to have a dog on the property.
Applicant (you),
Including yourself, how many adults (18yrs & older) live in the home? ___
How many children? ____ Age of the youngest child? ____
If you don’t presently have children, will you keep the dog if you decide to?
________________________________________________________________________________________________________________________________
__________________________________________
Are there pets In the household? YES NO
If yes, Please list the species, size, sex and age of each pet
• ______________________________________________________
• ______________________________________________________
• ______________________________________________________
• ______________________________________________________
• ______________________________________________________
___________________________________________
Which sex of dog would you prefer? MALE FEMALE
What are the qualities you like in this breed?
________________________________________________________________________________________________________________________________________________________________________________________________
Are you familiar with the characteristics of the breed?
________________________________________________________________
Where will this dog spend the day?
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Where might this dog spend it’s night? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
About how many hours per day might this dog be alone? _______________
___________________________________________
What made you interested in adopting this dog? ________________________________________________________________________________________________________________________________
Are you willing to work with us or a trainer should problems arise?
YES NO NOT SURE
___________________________________________
A fourth sheet is attached so you may provide two non related references that we may check. This information is ONLY used for THIS adoption. The references will NEVER be contacted for any other reason or by any other person than the foster parent.
___________________________________________
Additional Questions?
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Adoptee:
Name:_____________________
Signature:_________________________
In the absence of my signature, by submitting this form to Penelope’s foster parent. I certify that all the above information is correct; that the dog I adopt will reside in my home as a pet; that I will consistently provide the dog with proper nutrition, water, training, attention, medical care and my love and affection; I will treat this dog kindly and not subject it to cruelty or abuse. I also understand that I will pay a non-refundable adoption fee of _______________________ ($_____) to the foster parent at the time of adoption. I also certify that in the event I cannot keep the dog I will inform the foster parent for approval of new home OR relinquish ownership to the foster parent.