Name..........

Address.......

City:... .....State: .....Zip:

Home telephone:...................................................

Best time and day to call: ......................................

Place of employment: ............................................

Work telephone: ...................................................

Best time to call:.....................................................

If you would prefer us not to call at work, please explain why:

People residing in home:

Spouse/partner: ........

Other adults:.............

Children:

Age: Age:

Age: Age:

Is EVERYONE in your home agreeable to having a pet? ........Yes ...........No

Who will be primarily responsible for the pet's care and training?

Does anyone in the household have any allergies to animals? ........Yes ....No

If yes, please provide a brief explanation:

Do you have a veterinarian you have used before and plan to use with your new pet?

............................................................................................Yes ............No

If yes, please furnish the following:

Name

Street:

City ..............................State Zip:

Office Phone number:

Hours they are open:

Home

Is yours a: Single family home Townhouse/Condo Apartment

Other ........Explain

If you rent, is your landlord agreeable to you owning a pet? .......Yes .....No

Are there any covenants or restrictions on pets where you live? ..Yes ....No

If yes, please explain

Are there any restrictions or laws regarding Pitbulls in your community? If so, explain.

Does fencing completely enclose your property? .............Yes ..........No

Type ...............Height

If no, please explain how and where you will exercise a dog and allow it to relieve itself:

Lifestyle

Is someone normally at home during the day? ..................Yes ........No

If not, how many hours will the dog be alone on a normal weekday?

Where will the dog spend the day? Ctrl-click for multiple answers. Loose Indoors Crate Basement Garage Fenced Yard Dog Run Chained Outside Kennel Run Loose Outdoors Other

Explain if other

Do you travel frequently? .................................................Yes ........No

If yes, who will take care of the dog while you are away?

Is your lifestyle such that friends, relatives and children gain admittance

to your home, property and car without your permission? ....Yes .......No

If you have children, are you willing to accept the additional responsibility

of a rescue animal? ................................Yes ......No

Are you willing to teach the children the proper treatment and handling of a live animal?

..............................................................Yes .......No

Have you carefully considered the financial cost of pet ownership and are you financially prepared to give your pet the routine medical care it requires? .Yes .... No

Pet History

Do you currently own one or more pets? ....................Yes .........No

Please describe all pets by breed, sex, age, how long owned, spayed/neutered. Use back of page if more space is needed.

Breed Sex Age How long owned Spayed/Neutered

Have you ever owned a Pittbull in the past? ..................Yes .....No

Were any of these rescue animals? ................................................Yes ......No

Have you ever trained one or more pets? .........................Yes .......No

Explain:

Have you ever bred a pet? ......................................Yes .....No

If yes, explain:

What is your opinion on dog fighting, game testing, or "rolling", pitbulls or other breeds?:

Are you aware that dog fighting is illegal? ........Yes ........No

References

Please provide the names, addresses and phone numbers of at least three (3) people who can recommend you as a proper adoptive family for a rescued pet.

Name....

Address

City ....State ....Zip

Phone

Name....

Address.

City. .....State .....Zip

Phone

Name

Address

City .....State .....Zip

Phone

Placement Agreement

Loving Arms is a non-profit, applying for status. We are working to ensure the welfare of our dogs by rescuing, rehabilitating and placing them in loving, caring, responsible homes. We do not sell dogs.

To continue our work, we do require an adoption donation. If approved, you will be asked to sign this application and placement agreement as an adoption contract. It will be required among other things, that the dog be returned to Loving Arms immediately should you no longer be able to keep it. It may not be sold, transferred, or given to any individual, or establishment. All dogs will be spayed/neutered prior to placement, the only exception being puppies under twelve weeks of age. Puppies are required to be spayed or neutered on or before their six month birthday. Under no circumstances are dogs to be bred. Loving Arms retains the right to reclaim the dog if proof of spay/neuter is not provided at such time as the dog turns six months old. You will also be required to take the dog to a veterinarian within three days of the contract for a check up and any necessary treatment.

All of the information I have given in this questionaire is true and complete. Should a rescue animal be placed with me, it will reside in my home as a pet. I agree to provide the dog with adequate food, shelter, affection and medical care. I understand about the tempermant, habits, and physical condition of the dogs available for adoption.

Loving Arms and any of its representatives are not responsible for any damage, accident or injury due to the placement of a dog into my household.

We reserve the right to refuse and/or reject an application for any reason.

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