NOVA ROTTWEILER RESCUE ADOPTION APPLICATION

NAME OF DOG(S) INTERESTED IN:

______

PLEASE PRINT

DATE:______INTERVIEWED BY:______

APPLICANT’S NAME(s)

______age:______

______age: ______

CO APPLICANT’S NAME:______

PLEASE LIST ANY OTHER ADULTS IN YOUR HOME:

______age: ______

______age: ______

ADDRESS:______

CITY, STATE & ZIP CODE:______

HOME PHONE: ( )______

WORK PHONE: ( )______

EMAIL:______(required)

CELL PHONE:______

ARE YOU A HOMEOWNER: YES____ NO____

IF YES IS YOUR NAME ON THE MORTGAGE PAYMENT BOOK:______

IF NO THEN YOU ARE NOT THE HOMEOWNER. PLEASE STATE WHO IS:

NAME:______PHONE:______

CIRCLE TYPE OF HOME: TOWNHOME CONDO SINGLE FAMILY APARTMENT

OTHER:______

COUNTY YOU RESIDE IN:______

WHY YOU WANT TO ADOPT A DOG? ______

______

HAVE YOU EVER OWNED A DOG BEFORE? YES NO

HAVE YOU EVER OWNED A ROTTWEILER BEFORE?______

ARE YOU WILLING TO ADOPT A ROTTWEILER WITH NATURAL LONG TAIL?______

DO YOU NOW, OR HAVE YOU EVER OWNED ANY OTHER PETS BEFORE?

YES NO

IF YES, WHAT KIND OF PET?______

WHAT HAPPENED TO YOUR PREVIOUS PET(S)?______

______

WHICH PETS DO YOU STILL OWN?______

DO YOU CURRENTLY OWN A DOG: YES NO

IF YES PLEASE LIST EACH DOG AND HOW OLD IT IS:

______AGE:______

______AGE:______

______AGE:______

HAVE YOU EVER GIVEN A DOG AWAY BEFORE? YES NO

IF YES PLEASE EXPLAIN:______

______

IF YOU CURRENTLY HAVE A DOG, HAS YOUR DOG EVER LIVED WITH

ANOTHER DOG BEFORE? YES NO

IF YES, HOW LONG AGO?______

IF YOU CURRENTLY OWN A DOG OR CAT, IS IT SPAYED OR NEUTERED?

YES NO

IF NO PLEASE EXPLAIN WHY NOT:

______

WHAT DO YOU THINK ARE THE MOST IMPORTANT RESPONSIBILIES OF OWNING A DOG?______

ARE YOU ADOPTING A DOG FOR YOURSELF OR BECAUSE YOU HAVE CHILDREN THAT WANT ONE?______

2.

IF YOU HAVE CHILDREN THAT WANT A DOG, ARE YOU PREPARED TO SIGN AN ADOPTION CONTRACT THAT STATES YOU ARE THE LEGAL AND PRINCIPLE CARETAKER?______

IS/WAS YOUR DOG ON HEARTWORM PREVENTATIVE: YES NO

NAME OF THE HEARTWORM PREVENTATIVE:______

PLEASE GIVE THE NAME(S) OF YOUR VETERINARIANS ______

THE NAME(S) OF THE ANIMALHOSPITALS, AND PHONE NUMBERS ______

______

______

HOW MANY PEOPLE CURRENTLY RESIDE IN YOUR HOME?______

ARE THERE ANY CHILDREN? YES___ NO____

IF YES, WHAT ARE THEIR AGES:______

______

HAVE YOUR CHILDREN EVER LIVED WITH A DOG BEFORE?______

IF YOU RENT, PLEASE GIVE THE NAME AND PHONE NUMBER OF YOUR

LANDLORD:______

WHO WILL BE RESPONSIBLE FOR FEEDING THE DOG, TAKING IT TO BASICOBEDIENCESCHOOL, AND TO THE VET:______

WILL THE DOG HAVE FREE ROAM OF YOUR HOUSE:______

IF NOT, WHERE WILL THE DOG BE KEPT:______

HOW MUCH TIME WILL THE DOG BE SPENDING OUTSIDE:______

DURING THE WEEK, WHILE AT WORK, HOW LONG WILL THE DOG BE LEFT ALONE:______

IF YOU PLAN TO GO AWAY, WILL YOU TAKE THE DOG, BOARD THE DOG, OR GET A PETSITTER:______

DO YOU HAVE A FENCED YARD:______

IF YES, PLEASE ACCURATELY DESCRIBE WHAT TYPE OF FENCE AND HOW HIGH:______

DO YOU HAVE GATES THAT CAN BE LOCKED:______

ARE YOU WILLING TO SIGN A LEGAL ADOPTION

CONTRACT:______

ARE YOU AWARE THAT ALL DOGS ARE SPAYED OR NEUTERED PRIOR

TO ADOPTION:______

PLEASE LIST YOUR PREFERENCE OF APPROXIMATE AGERANGE:

______

PREFER A MALE OR FEMALE?______

PLEASE BE ADVISED THAT SIGNING A LEGAL ADOPTION CONTRACT

MEANS THAT YOU ARE OBLIGATED TO ALL THE TERMS IN

THE CONTRACT OR THE DOG MUST BE RETURNED TO NOVA

ROTTWEILER RESCUE, OR THE DOG WILL BE REDEEMED THROUGH

A CLAIM AND DELIVERY SERVICE.

LIST 3 REFERENCES THAT ARE NOT RELATIVES:

NAME,ADDRESS, AND PHONE NUMBER(S)

TO MAIL YOUR APPLICATION:

NOVA ROTTWEILER RESCUE

POBOX 1777

GERMANTOWN, MD20875