Rottweiler Hearts Rescue

RHR Adoption Application

Mailing Address
Rottweiler Hearts Rescue
404 Loblolly Circle
Clayton, NC 27520 / The RHR adoption application is part of a multi-step process. Once we get your completed adoption application and the non-refundable $25 adoption application processing fee, the RHR Adoption Committee will contact your veterinarian and personal references. Meanwhile, a home visit with you and your family will be scheduled and completed before RHR can consider approval of you adoption. Rottweiler Hearts Rescue reserves the right to deny any application for any reason.
Please fully complete the RHR Adoption Application then submit this form, along with your non-refundable $25 adoption application processing fee, to Rottweiler Hearts Rescue. The Adoption Application form can be sent via email to our Adoption Team at: or mailed to us directly. Payments are accepted via money order, cashier's check, personal check*, cash, or PayPal. PayPal payments can be made directly from our website by clicking the "Donate" button and following the instructions. (A PayPal account is not required.).
Applications are normally processed within 7 to 10 business days of receipt of application and application fee.**
Non-Local Adoptions
RHR operates within a two-hour radius and adopt to within a 6-hour radius of Raleigh, NC.
For those outside of our operational area, we try to find a local trustworthy large or bully-breed rescue to complete the home visit. If no suitable rescue can be found, we reserve the right to deny the application. The adopter is responsible for all transport costs.
Application Submission Date:
Which RHR Rottie(s) are you interested in?

Applicant(s) Information

Applicant’s Name(s):
Address, City, State, & Zip:
Email Address:
Cell Phone: / Are you 18 years old or older?
Home Phone: / Do you own or rent your home?
Work Phone: / Are there size or breed restrictions?
Insurance Co. / Do you have permission to own a pet / rottweiler?
NOTE: If you rent or belong to a HOA, RHR needs written confirmation from your landlord or HOA verifying Rottweilers are not restricted.

Reference Information

Please provide us with three references of friends, neighbors, or co-workers who are not family members.

1. / Name: / Phone:
Email: / City:
2. / Name: / Phone:
Email: / City:
3. / Name: / Phone:
Email: / City:

* If your check is returned to RHR for any reason, including non-sufficient funds (NSF), you are not only responsible for the $25 adoption application processing fee but in addition, you are responsible for a $35 NSF fee payable to RHR. Your application will not be processed until all fees have been paid in full by cash, money order, cashier’s check, or PayPal.

** Application process time is dependent upon availability of references and veterinarian(s) and clearance of funds. To ensure your application is processed timely, notify your listed references and veterinarian that they will be contacted by an RHR representative.

Family and Household Information

Are there children in the household? / If Yes, what ages?
Are there others in the household? / If Yes, what is relationship?
Is anyone in household allergic to dogs? / If Yes, please consider your decision carefully.
Is everyone in the household in agreement about adopting a dog from RHR?
Do you have a fenced yard? / Is it a shared fence?
If Yes, how high and what type is the fence?
If No, how will the dog be pottied & exercised
Why are you considering adopting a dog? / ___ Companion for Self / ___ Gift
___ Companion for Other Household Member / ___ Companion for Child / ___ Watch Dog
___ Other: / ___ Companion for Other Pet / ___ Best Friend
It is most important to me that my dog…:

Pet and Vet Information

Do you currently have pets or have had pets in the pasts?
Current Veterinarian’s Name and Phone:
When was your pet’s last visit to the vet? / Reason for visit?
Previous Vet’s Name and Phone Number:
Have you even given a pet away or taken a pet to a shelter?
If yes, what were the circumstances?
Have you ever applied for a pet through another rescue?
If yes, which rescue and what was the outcome?
Name / Breed / Age / Gender / Fixed / Where are they now?

New Pet Information

Who in the household will be the dog’s primary care giver?
Are you willing/prepared to potentially spend large amounts of money for emergency vet care if needed?
Comments:
If you move, what do you plan to do with your pet?
How many hours each day will the dog be left unattended?
Where will the dog be during the day? / At night?
What about when no one is home / Out of Town?
What would you do if the dog had an accident in the house? How will you correct your dog’s behavior?

Additional Information

Rottweiler Hearts Rescue will provide an honest evaluation of the temperament of every RHR dog the best of our abilities. If behavioral problems present themselves at a later day, are you committed to working with the animal to correct the problem?
What reasons would make you consider returning your adopted dog?
How did you first hear about this dog?
Additional Comments — Applicants are free to add any additional comments or information they feel is pertinent to the application and/or adoption.

Authorization and Agreement Terms

_____ (Initial) I certify that the information provided on this RHR Adoption Application is true and correct to the best of my knowledge. I understand that, prior to being approved for adoption, this information will be verified. I authorize a RHR Representative to contact those references listed on this application. In addition, I authorize a RHR Representative to contact my veterinarian for reference.

_____ (Initial) I understand that, prior to being approved for adoption, a home visit will be scheduled and all members of the household must be present. Furthermore, I authorize a RHR Representative to visit my home prior to and after the adoption to do follow up visits on my adopted dog. If upon inspection, RHR finds that the information contained in this application to be false, RHR retains the right to deny my application or remove the dog from my premises without a refund of monies paid.

_____ (Initial) I certify that I have checked with my city/county jurisdictions and by adopting this dog and bringing him/her into my home that I will not be in any violation of my city or local ordinances.

_____ (Initial) I certify that I have checked with my homeowner’s or renter’s insurance agent and by adopting this dog and bringing him/her into my home that I will not be in any violation of my insurance agreement.

_____ (Initial) I am financially and physically able to care for this animal. I understand that proper food and veterinarian care can be costly and I am able and willing to meet these requirements. Approved adoptions require a signed Adoption Contract by both the Adopter and by a member of the Rottweiler Hearts Rescue Board of Directors to be valid.

_____ (initial) I understand that the Rottweiler Hearts Rescue cannot guarantee any dogs to be purebred.

I, ______(applicant's name), give ______(Veterinary Clinic) permission to release any and all requested documents on any and all pets that are or have resided in my household for the last five years from the date of this application to a Rottweiler Hearts Rescue representative. Authorization will expire one year from today, the ___ day of ______, 20_____.

Signature (signing this form acknowledges the above statements) / Date

V6.0 – September 16, 2015 RHR Adoption Application 3 of 3 Pages