First Name*

Last Name*

Email*

MICROCHIP:

DATE:*

DOG#

PET'S NAME:

SOURCE/FOSTER

RU4ME DOG APPLICATION

Not all pets are suitable for all homes. The information you provide will help us make the best match for both you and the pet. Completing an application does not guarantee adoption. We reserve the right to deny ANY application.

APPLICANT NAME*

DOB:*

HOME PHONE:

HOME ADDRESS*

CELL PHONE*

EMAIL ADDRESS*

CO-APPLICANT NAME

D.O.B.

CELL PHONE:

EMAIL:

CITY

STATE:

ZIP

HOW LONG HAVE YOU LIVED AT THIS ADDRESS?*

DO YOU PLAN ON MOVING WITHIN THE NEXT 12 MONTHS?

If SO, EXPLAIN

IF YES, WHAT WILL HAPPEN TO THIS PET WHEN YOU MOVE?

APPLICANT WORK INFO:

I WORK (check all that apply)

EMPLOYER:

EMPLOYER ADDRESS:

PHONE NUMBER OF PLACE OF EMPLOYMENT

LENGTH OF EMPLOYMENT:

If renting we must have a copy of a lease in your name that permits pets, proof of payment of pet deposit if required and/or written consent from your landlord allowing pets before the pet can go home.

LANDLORD NAME

LANDLORD PHONE

CO-APPLICANT WORK INFO:

NAME OF EMPLOYER

EMPLOYER ADDRESS

WORK PHONE

LENGTH OF EMPLOYMENT?

DO YOU OR ANYONE YOU LIVE WITH WORK FOR A COMPANY THAT REQUIRES FREQUENT MOVES?

FAMILY LIFE:

LIST OTHER ADULTS IN HOUSEHOLD*

LIST CHILDREN AND THEIR AGES, INCLUDING THOSE WHO VISIT REGULARLY*

HOW DO OTHER HOUSEHOLD MEMBERS FEEL ABOUT HAVING A PET?

DOES ANYONE OBJECT TO ADOPTING A DOG?

DOES ANYONE HAVE ALLERGIES?

WHO WILL HAVE THE MAJOR RESPONSIBILTY FOR THIS PET?*

THE REASON'S YOU WISH TO ADOPT THIS PET? (check all that apply.)

HOW OFTEN DO YOU TRAVEL?*

WHERE WILL YOUR PET STAY WHEN YOU TRAVEL?*

WHERE WILL THE PET STAY DURING A HURRICANE?*

CURRENT AND PAST INFORMATION:

HAVE YOU ADOPTED FROM RU4ME PET RESCUE BEFORE?

IF SO, WHEN?

CAT OR DOG?

HAVE YOU EVER GIVEN A PET TO A SHELTER?

HAVE YOU EVER PLACED YOUR PET WITH SOMEONE ELSE?

WHAT OTHER PETS DO YOU OWN? (Please list: SPECIES, BREED, AGE, SIZE)*

ARE THEY ALL SPAYED OR NEUTERED?

ARE ALL OF YOUR PETS CURRENT ON SHOTS?

DO ANY OF YOUR PETS HAVE MEDICAL CONDITIONS?

IF YOU DO NOT CURRENTLY OWN A PET, HAVE YOU EVER OWNED ONE IN THE PAST?

IF YES, WHAT HAPPENED TO YOUR PRIOR PETS?

PLEASE PROVIDE YOUR VETERINARIAN'S NAME AND PHONE NUMBER:

DO YOU HAVE A CURRENT RECORD WITH THIS VET?

DATE OF LAST VISIT WITH THIS VET?

I UNDERSTAND THAT BY TYPING MY NAME BELOW, I AUTHORIZE MY VETERINARIAN TO RELEASE ANY INFORMATION ON MY CURRENT OR PREVIOUS PETS. *

PROVIDING CARE FOR MY PET:

DO YOU UNDERSTAND AND AGREE TO PROVIDE NECESSARY VETERINARY CARE FOR THIS PET INCLUDING RABIES/DISTEMPER/PARVO VACCINATIONS, FLEA CONTROL AND ANNUAL HEARTWORM CHECKS AND USE A HEARTWORM PREVENTATIVE?

IS THIS TO BE AN INDOOR/OUTDOOR PET? AN OUTDOOR PET? IF OUTDOOR ONLY, PLEASE EXPLAIN WHAT TYPE OF SHELTER YOU WILL PROVIDE?

WHERE WILL THIS SPEND ITS TIME DURING THE DAY?*

WHERE WILL THIS PET SPEND ITS TIME DURING THE EVENING?*

WHAT IS THE MAXIMUM TIME THE PET WILL BE LEFT ALONE?*

HOW OFTEN?

IS THERE AN ADULT HOME DURING THE DAY?

IS THERE AN ADULT AT HOME DURING THE EVENING?

IS YOUR YARD COMPLETELY FENCED?

TYPE OF FENCE?

HOW HIGH IS YOUR FENCE?

IF YOU DO NOT HAVE A FENCE, HOW DO YOU PLAN ON EXERCISING YOUR DOG?

WHERE WILL THE NEW PET SLEEP?

DO YOU CURRENTLY HAVE A PET DOOR IN YOUR HOME?

DO YOU HAVE A POOL?

DOES YOUR POOL HAVE A CHILD-PROOF BARRIER FENCE?

IS YOUR HOME MORE THAN ONE STORY?

What brand of food do you currently use?

BESIDES FOOD, WHAT OTHER TYPE OF ITEMS DO YOU PLAN TO HAVE ONHAND FOR YOUR NEW PET?

DO YOU PLAN TO TAKE YOUR DOG TO OBEDIENCE TRAINING?

WOULD YOU USE CRATE TRAINING IF NECESSARY?

IF YOUR NEW PET WERE A BREED THAT WAS A CANDIDATE FOR COSMETIC SURGERY, WOULD YOU HAVE IT DONE?

IF SO, WHAT PROCEDURE WOULD YOU HAVE DONE?

WHAT DO YOU ESTIMATE WILL BE THE AVERAGE ANNUAL COST OF FOOD, SUPPLIES AND MEDICAL CARE FOR YOUR NEW PET?

DO YOU FEEL YOU CAN AFFORD THETHE COST OF MAINTAINING YOUR PET BOTH NOW AND FOR THEIR LIFETIME (15+ YEARS)?

WHAT WOULD YOU DO IF YOUR PET SUDDENLY REQUIRED IMMEDIATE MEDICAL CARE EXCEEDING $500.00?*

COMING HOME:

WHAT PROVISIONS HAVE YOU MADE FOR THE INTRODUCTION OF THIS NEW FAMILY MEMBER TO YOUR HOME?

DO YOU UNDERSTAND THERE MAY BE SOME ADJUSTMENT PROBLEMS, AT FIRST, WHICH MAY REQUIRE TRAINING AND ADDITIONAL ATTENTION?

ARE YOU ABLE AND WILLING TO WORK WITH THIS PET IN THIS REGARD?

WHAT TYPES OF BEHAVIOR WOULD CAUSE YOU TO RETURN THIS PET?*

WILL YOU AGREE TO CONTACT RU4ME AND RETURN THE PET IF YOU CAN NO LONGER KEEP THIS PET FOR ANY REASON?

DO YOU UNDERSTAND THAT YOU CANNOT SELL OR GIVE THIS PET TO ANYONE?

PLEASE PROVIDE THREE REFERENCES INCLUDING THEIR NAME, RELATIONSHIP TO YOU AND THEIR PHONE NUMBER.*

DO YOU UNDERSTAND THAT REFERENCES WILL BE CHECKED?

DO YOU UNDERSTAND AND AGREE TO ALLOW RU4ME PET RESCUE TO CONDUCT A PRE-ADOPTION HOME VISIT SHOULD THEY DEEM IT NECESSARY?

HOW DID YOU FIND OUT ABOUT RU4ME PET RESCUE?*

I GIVE RU4ME PET RESCUE PERMISSION TO VERIFY ANY AND ALL INFORMATION GIVEN BY ME ON THIS APPLICATION. I UNDERSTAND THAT ANY FALSE INFORMATION GIVEN WILL DISQUALIFY MY APPLICATION TO ADOPT AND I WILL BE REQUIRED TO IMMEDIATELY SURRENDER THE PET TO RU4ME PET RESCUE.

TO BE SIGNED IN STORE:

APPLICANT SIGNATURE:                                       DATE:        /     /

CO-APPLICANT SIGNATURE:                                 DATE:       /     /

RU4ME REP SIGNATURE:                                      DATE:       /     /