Who will be the dog's primary caretaker?

Do all members of the household want a pet?  Yes  No

Do any family members have asthma or allergies?   Yes   No

Do you currently own or have you owned a pet before?  Yes  No

If yes, how long did you have your pet?  

If no longer with you, what happened to him/her? (If passed away, please give circumstances)


What other pets live with you? (please give numbers, ages, breeds and sexes)


Are they all spayed/neutered?  Yes  No

If any of them are not spayed/neutered, would you consider that as a condition of adoption?  Yes  No

If you live in an apartment condo, what is the weight limit?

Do you rent or own your home?  Rent  Own

If you rent, please provide us with contact information for your landlord.


IMPORTANT: Many homeowner's insurance companies have breed blacklists which include, but are not limited to, pit bulls, American Pit Bull Terriers, American Staffordshire Terriers, Staffordshire Bull Terriers, Rottweilers, Dobermans, Akitas, American Bulldogs, Chows and wolf-hybrids and will not insure you if they reside in your home or may cancel your insurance if you add a dog of these breeds to your home. Please check your homeowner's insurance policy regarding breed discrimination before submitting this application to adopt a pit bull type dog. Landlords may also have these same breed restrictions due to their insurance policies. Please check this out before applying to adopt one of these breeds.

Do you have a yard?  Yes  No

Is the yard fenced?  Yes  No  N/A

  If yes, what type of fence?   

  If yes, approximately, how high is the fence at the lowest point?  

Do you have a pool?  Yes  No

  If yes, is there a fence around the Pool?  Yes  No  N/A

Is the recipient of the gift aware or your intentions?   Yes  No

Where is your pet going to be when you are home? (Check all that apply)
Dog will be a house pet, living inside with the family
Dog will live in the basement or garage primarily
Dog will live outdoors primarily
Dog will live in a fenced dog run with a dog house
Dog will have a job as a guard dog for: Business    Residence
If you checked the 'Guard Dog' box, please explain the nature of the dog's responsibilities:

Other:

On average, how many hours per day will your pet be left alone?

When home alone dog will be (check all that apply):
In a crate, wire crate or dog pen inside
In an enclosed kennel outside
Tied up outside: On a cable run   With a chain
Dog will be loose indoors
Dog will be loose outdoors
Other:

How do you plan on keeping your pet exercised? (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 run & play together off-leash)
Other:

Describe what kind of training you will provide for your pet.

Under what circumstances would you not be able to keep your new dog? (Please check all that apply:

I would not be able to keep my dog if the following possible Personal Changes came upon me

I would need to relinquish me dog if they developed the following possible Health Problems
Dog incurs expensive vet bills
Requires daily treatment
Needs special diet
Dog becomes disabled
Other: 

Do you plan on taking your new dog to Obedience School? Yes  No

Have you ever been in a situation where you were not able to keep a pet? Yes  No
If Yes, please explain:

Were you ever in a situation where you had to bring a dog to the shelter? Yes  No
If Yes, please explain:

Do you travel often? Yes  No
Who would take care of your pet while you were away?

Who would you give the dog to if you moved?

There are a lot of true and false statements made about Pit Bulls in the media. What are some truths that you know about the breed??

Is there any other information you feel that we should know about you?

By checking YES you agree to the MANDATORY obedience training of this dog. You must complete an obedience course and provide us with proof of completion.
Yes  No

I have read the above information carefully and have filled out this application honestly. I understand that omission of information and/or failure to answer all questions can result in the application being declined. Also, if an omission or untruth is discovered after the adoption takes place, I understand and accept that PBRSD has the right to annul the adoption and reclaim the dog.

Yes  No