17. Do you live with: Spouse/partner Roommate(s) Parents Alone
18. How many adults (21 and older) in your household?
19. How many individuals under 21 in your household?
20. What are the ages of the individuals under 21?
PART 2- Liability and responsibility
The three following questions must be answered or your application won't be considered.
21.* By checking YES you agree to absolve Pit Bull Safe Haven Rescue, Inc. and all of its representatives from any liability in reference to a dog featured in this web site. YESNO
22.* By checking YES you agree that the dog will not be used in any illegal activities nor be found at any time in a municipality where Pit Bull presence is illegal. YESNO
23.* By checking YES you agree that the dog is to be kept as a house pet. It shall not be sold for medical or experimental purpose, and it shall not be used for breeding. YESNO
PART 3- Dog(s) you are interested in adopting
Please provide the name of the dog(s) you are interested in adopting.
24. Choice#1 (required)
25. Choice#2 (optional)
26. Choice#3 (optional)
27. Choice#4 (optional)
28. * Are you looking for a:MaleFemaleEither
29. Do you prefer a: PuppyAdultEither
30. If you have a preference in color and weight, please describe it here:
31. Prefer dog to be: (check all that apply) Already spayed or neutered Not spayed or neutered Doesn't matter
32. Additional requirements about the dog you would like to add:
PART 4- Living situation and lifestyle
33. Dog's living situation (check all that apply) Dog will be house pet, living inside with family Dog will live in basement or garage Dog will live outdoors Doghouse provided Guard Dog for: Business Residence Other - please specify:
34. How many hours a day will dog be home alone?
35. When home alone dog will be (check all that apply): In a crate, wire cage, or dog pen inside In a Kennel: Outdoor Indoor Both Tied up outside: Cable Run With a chain Dog will be loose: Indoor Outdoor Other - please specify:
36. How will you exercise the dog? (check all that apply) Leash walks every day Will have cable or dog run in the yard Will be free to run in fenced yard Will have supervised access to unfenced yard Will be free to roam around (Off leash and unsupervised in unfenced area) Will bring to dog park (Public area where dogs can run and play together off-leash) Other:
37. Is the home in anUrbanSuburbanRuralsetting?
38. Yard size is:SmallMediumLargeAcreageNo Yard
39. Is the yard enclosed by a fence? YESNO
40. If so, height, length, and type of fence:
41. Do you live in aHouseApartment ?
42. Do you own the property?YESNO
43. If you are renting, please provide Landlord's name and phone number for verification:
44. Does your municipality have breed specific restrictions? YES NODon't know
45. If so, please describe the nature of the restrictions:
PART 5- Other Pets and experience
46. Do you have other DOGS? (Check all that applies) No other dogs One or more spayed female One or more neutered male One or more UNspayed female One or more UNeutered male
47. Please specify breeds and ages of other dogs:
48. If you had other dogs in the past, please let us know their current disposition: Still have the dog(s) Died of old age fatal disease Gave or sold to friends, relatives or acquaintance Was hit by a car Was stolen Disappeared/Lost
49. Please specify what happened.
50. What other kind of animals do you own?
51. Of all the breeds available why do you want a Pit Bull ?
52. Are you familiar with Crate Training? YES NO
53.What Method of Housebreaking will you use ?
54. Experience: Please relate any prior experience you have had with this breed:
55. * References: Please supply the name and phone number of your current veterinarian, or the one who saw your previous pet(s). In addition, please supply three references not related to you who can attest to your character.
56. Additional information you would like to provide about yourself and/or the dog you would like to adopt:
Please review ALL the information provided before you submit your application.