Dog Adoption Application Step 1 of 6 16% Adoption ApplicationTo help ensure the best possible placement of our rescued animals, and in order to determine that the proposed adoption is in the best interest of the animal, you, and your family, please complete each of the following questions. Please be as thorough as possible. Back The Blue Pet Rescue reserves the right to refuse adoption to any application.Name of Dog(s) of interest:*Dog Name Your Name* First Last Spouse/Partner/Roommate'sName(s) Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Drivers License Number Place of Employment: You live in a:*Select OneHouseApartmentCondo/TownhomeMobile HomeOtherIf "live in" is Other, describe: Do you Own or Rent:*Select OneOwnRentOtherIf own/rent is Other, describe: If renting, are pets allowed?*Select OneYesNo(We will need a copy of landlord's approval of addition of pet)Landlord's name and phone: Do you have a fenced-in yard or patio?*Yes / NoYesNoWhat type of fence?Select OneBlockChain LinkOtherIf fence type "Other", describe: Overall fence height:in feet Height at lowest point of fence:in feet Describe ground cover below any gate(s): If no fence, what arrangement will you make for potty duties? Describe yard / overall / coverage: Do you have a doggy door?*Select OneYesNoDo you have a swimming pool or spa?*Select OneYesNoIs your swimming pool or spa fenced?Select OneYesNoAre you able & willing to work with your new pet on how to get out of the pool/spa?Select OneYesNoNumber of adults in home:Please enter a number from 0 to 99.Number of children in home:*full-time or part-timePlease enter a number from 0 to 99.Number of children potential to visit:Please enter a number from 0 to 99.Age(s) of children: Have allergies to animals been a problem to any household members?Yes / NoYesNoAre all family members aware that you are wanting to adopt a pet?Yes / NoYesNoIf all family members are not aware, explain: Do you own other pets?*Select OneYesNoTotal number of pets:Pet details:*NameBreedMale / FemaleAgeSpayed / NeuteredYears owned Are your pets current on vaccinations?*Select OneYesNoHave you had other pets in the last five years that are no longer with you?Yes / NoYesNoIf yes, had pets and no longer with you, describe what happened to them?Have you ever given up a pet for adoption?Yes / NoYesNoIf yes, given up a pet, please explain circumstances:Have you adopted from Back The Blue Pet Rescue (BTBPR) before?Yes / NoYesNoHave you ever returned an animal to a rescue, shelter or county animal control facility?YesNo Will someone be home with your pet during the day? Yes No What is the greatest number of hours the pet will spend alone daily/nightly?* Where will the pet spend most of its time? Crate Indoors Outdoors Garage Basement Run Describe where your new pets' main sleeping quarters will be? Is there someone home at night? Yes No Do you plan to travel with your pet? Yes No If not traveling with pet, where will the pet stay while you are away? Friend or Family Kenneled In home pet-sitting Do you agree to seek obedience (humane) training for undesirable behaviors? Yes No Do you commit to providing a home for this pet for its lifetime, despite changes in your life such as moving, having a baby / grandchildren, or getting a divorce? Yes No What would this pet have to do for you to consider returning him/her? Would you allow a BTBPR representative to do a home check?(home checks simply ensure the safety of the environment for the animal, not to check housekeeping) Yes No Name of current veterinarian / animal hospital: Post Adoption Requirements (must agree to all) Be 21 years of age or older. You would return the animal to BTBPR if you feel for any reason you cannot keep him/her. You must not sell or otherwise rehome the animal without notifying BTBPR. Have identification showing your present address and have the knowledge and consent of your landlord. You are responsible for providing proper shelter, food, water, exercise, medical are and humane treatment at all times for your dog(s). You are will and financially prepared for long-term medical and dental care for the dog(s). I certify that the information given on this application is true and correct. If I am approved by BTBPR to adopt an animal, I agree to all the above requirements. I understand that failure to comply with any of the requirements will result in confiscation of adopted animal. Dog Adoption Application PDF Volunteer Apply Online Donate Wish List How to Help Become a Foster Learn More Volunteer Learn More Donate Learn More
