● Name of animal you are interested in: _________________________________
● First & Last Name: _________________________________________________ ● Are you over 25: ________________________________________________________ ● Email address: __________________________________________________________ ● Address, City, State, Zip: __________________________________________________ ● Phone Number (including area code): ________________________________________ ● Are you employed? (Please specify): _________________________________________ ● Type of Residence (Please specify): __________________________________________ ● Do you Own or Rent: _____________________________________________________ ● If you Rent, does your landlord allow pets: ____________________________________ ● Landlords Name & Number: ________________________________________________ ● Do you plan to move in the near future? ______________________________________ ● Are other family members aware that plan to Adopt a pet? ______________________ ● Reason for Adoption: ______________________________________________________ ● How many adul ts live in the household? _____________________________________ ● Full names of all adults: ____________________________________________________ ● How many children live in the household? _____________________________________ ● Age of child/children: _____________________________________________________ ● Do you have pets now? ___________________________________________________ ● What kind of pets? _______________________________________________________ ● How many of each kind? __________________________________________________ ● If you have pets, how many are spayed/neutered? _____________________________ ● How many are up to date on shots? _________________________________________ ● What kind of pets have you had in the past? __________________________________ ● What happened to your last pet? ___________________________________________ ● Have you ever had to give up a pet? If YES, Please explain: _______________________ ● Is anyone in the house allergic to animals? ____________________________________ ● Do you have a present vet? If YES, vets name & Number? ________________________ ● Will your pet live Inside or Outside? _________________________________________ ● If inside, how do you plan to train? _________________________________________ ● If outside, how do you plan to confine? ______________________________________ ● Do you have a fenced yard? ________________________________________________ ● Are you aware of and prepared to meet the first year’s cost of regular preventive veterinary care ( approximately $100 - $200), food, and supplies ($100-$150):________ ● Do you feel willing and able to work with your dog to correct problem behavior if it should develop (Barking, destructive clawing, jumping, or digging)?________________ ● What are your ideas for dealing with such behavior? Please note that not all problem behavior can be corrected. Most behavior can be corrected with patience, perseverance, and/or expert help: _________________________________________ ● Do you have any poisonous or toxic plants like ivy, philodendron, or poinsettia? _____ ● If you have poisonous or toxic plants, would you be willing to place them out of reach or remove them from your home?____________________________________________ ● Who will be responsible for your new dog’s care? ______________________________ ● How many hours of a day will your dog be alone? ______________________________ ● How many days of the week will your dog be alone? ____________________________ ● Where will your dog be kept when they are alone? _____________________________ ● Your dog will be micro-chipped for permanent identification. Do you agree to register your dog with the 24 hour Pet Watch database (this is FREE and will not cost you for the first year)? __________________________________________________________ ● If you move, will you update this information with 24 Pet Watch and Unbreakabull Bullies? ________________________________________________________________ ● Note: Since your dog will be wearing a collar, please be sure to use a safe dog type collar. These collars easily break off or expand to slip over the head if your dog is caught on something. Do not use a pinch or choke chain. Unbreakabull Bullies, and Iowa Law require that adopted animals be altered (spayed/neutered). Do you agree with this policy? ________________________________________________________ ● Are you prepared to give your dog plenty of time to adjust to its new home? We encourage the 2 day, 2 week timeframe. It will take your dog approximately 2 day to become familiar with the new home and 2 weeks to become comfortable with the family and other pets. Will you give your new dog this time?______________________ ● Would you consider Adopting 2 dogs for companionship, especially if there is often no one at home? ____________________________________________________________ ● I certify that the information I have given is true. I authorize the investigation of all statements in this form. I understand that Unbreakabull Bullies has the right to refuse any request for adoption.