| Adoption Application |
| Name: Address: City, State, Zip: Email: Home Phone: Work Phone: Best Time To Call: Note: If you do not provide your phone number, your application will be discarded. Occupation: How long at present job? Are you: Single Married Live with parents Couple, not married Military Lifestyle: Extremely active Moderately active Somewhat Active Not Active Personal References (other than a family member) who are familiar with your experience as a pet owner. Please provide the following information for at least 3 personal references. Name: Relationship: Email: Day Phone: Evening Phone: Best Time To Call: Do you own or rent your home? If renting, do you have your landlord's permission to keep a dog? Landlord's Name: Phone: Type of residence: House Apartment Duplex Condominium Mobile Home Other Do you have a fenced yard? Height of fence: Does the fence completely enclose a yard for the dog? If no fence, how will you handle the dog's exercise needs and toilet duties? Do you have a separate kennel run? Height and size: Do you have a swimming pool and is it separately fenced? How many adults are in your household? How many children? Age and gender of children: Are all family members in agreement about adopting a PBGV? Does anyone in your family unit have asthma or allergies to animals? Do you have other pets or livestock? Please explain. Have you ever owned a PBGV? If yes, from whom was the dog acquired? If you no longer have the dog, what happened to it? If you haven't owned a PBGV before, have you ever spent any time with one? How did you learn about PBGVs and why did you decide on this breed? In your research on the PBGV, is there anything about the breed that causes you concern? Explain. Do you have any experience caring for a rescue dog? Where will the dog spend the day? Where will the dog spend the night? How many hours per day will the dog be alone? What will you do with the dog when you take vacations? Would you be willing to take a dog with minor health conditions or behavior issues? Do you prefer: Male Female No preference Are you willing to let a representative from PBGV LIfeline visit your home? If there are no PBGV Lifeline representatives in your area, we would like to forward your information to another rescue group in your area. May we share your information with other rescue organizations? I am over 18 years of age. I have reviewed and understand the PBGV Lifeline adoption procedures, adoption contract, spay/neuter policy and adoption donation By signing below, I certify that the above information is true. I give PBGV Lifeline permission to check my references, contact my veterinarian, and to make a home visit and followup calls. ________________________________________ Date: _____________________ (Signature) ________________________________________ (Print Name) Mail application to: PBGV Lifeline, c/o S. Leonard, 3119 N Winton Avenue, Indianapolis, IN 46224 |
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