Bless the Bullys: Pit Bull and AmStaff Rescue
Adoption Application

Bless the Bullys



1. * First Name:

2. * Last Name:

3. * Spouse' Name:

4. * Street Address:

5. * City:

6. * Zip Code:

7. How long at present address?

8. Are you moving?

9. Employer:

10. Home Phone #

11. Work Phone #

12. * Select State or Province:

13. * E-Mail:

14. Drivers License Number & State Issued

15. * How old are you?

16. Occupation:

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. YES   NO

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. YES   NO

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. YES   NO


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:  Male   Female   Either

29. Do you prefer a:  Puppy   Adult   Either

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)


37. Is the home in an Urban Suburban Rural setting?

38. Yard size is: Small   Medium   Large   Acreage   No Yard

39. Is the yard enclosed by a fence? YES   NO

40. If so, height, length, and type of fence:

41. Do you live in a House   Apartment ?

42. Do you own the property? YES   NO

43. If you are renting, please provide Landlord's name and phone number for verification:

44. Does your municipality have breed specific restrictions?
YES   NO   Don'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

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:

* 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.



Dogs Available for Adoption | Dogs Available for Adoption - Page 2 | Bully Friendly Advice | Adoption Application | Links

Once you have completed your application: 
(1) Click the e-mail link above;
(2) Copy and paste your completed application to a blank e-mail; and
(3) Forward it to us!   

Enter supporting content here