Date Dog of Interest NOTICE **No Dog may be adopted as a gift for another person****Home checks are a requirement before fostering begins or adoptions are complete.** Please note there is an adoption fee of $175. In some cases sponsors may sponsor all or part of an adoption fee for a specific dog. About YouName *Enter your first and last nameAge Enter your ageAddress Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryEmail Address Phone Number Occupation Employer Drivers License Number State Please list two personal references that we may contact Name Relationship Phone Name Relationship Phone About Your HomeHow many TOTAL OTHER PEOPLE live in your household? Please list their names, ages, and relationship to you: Is everyone in the household in favor of fostering/adopting? YesNoDoes anyone in the household have pet allergies? YesNoDescribe your home HouseCondoApartmentOther OwnRentSubletHOA MemberCo-Op MemberOther Front door opens to the streetFront door opens into a courtyard or entryway No YardUnfenced YardPartly Fenced YardCompletely Fenced YardFOR CONDO: Do the HOA rules allow pets? Any breed/size restrictions? FOR RENTALS: Please attach your landlord's written permission or applicable rental agreement page(s) Describe Your Yard SmallMediumLargeSize feet by feetSurface (grass, stone, etc) Height of fence (feet) The fence is made of: WoodChain LinkBrickInvisible FenceOtherNumber of gates Gates have locks? YesNoGates open on street side? YesNoWho has access to your yard besides you i.e. gardener, pool cleaner, children, utility, roommates, neighbors, other dogs, other pets About Your Experience with DogsIf you currently have a dogHow did you come to have the dog? How old was the dog when you first met? How many TOTAL OTHER PETS live in your household? For OTHER PETS, please answer the following for each pet:Name: Breed: Age Weight Gender: MFFixed YesNoName: Breed: Age: Weight: Gender: MFFixed: YesNoName: Breed Age: Weight Gender MFFixed: YesNoName: Breed: Age: Weight: Gender MFFixed YesNoHow would you describe your level of experience with dogs? Never had a dogChildhood petHad one or more dogs as an adultExperience with dogs Less than 30lbs30-60lbs60+ lbsSpecific Breeds? Dog-related business or professionFoster or rescue experience -Name of Organization General Questions (Please answer all questions)How long have you been thinking about adopting a dog? What are your primary reasons for wanting to adopt a dog? SecurityCompanionshipFor the ChildrenAs a gift for someoneFriend for a current petOtherWhen was the last time you had a dog? Breed? Was he/she neutered/spayed? YesNoWhat happened to the dog? Have you ever had an animal that required a major surgery for an injury/illness? YesNoIf yes, please explain Planning a Prospective Adoptive Care Experience (Please answer all questions)When you go on vacation, who will care for this dog? What kind of dog food will you feed this dog? Do you have a regular veterinarian? YesNoCan we contact your veterinarian? YesNoVet Name: Phone Number: Who will groom and bathe this dog? What do you use for flea control & heartworm prevention on current animals? Would this dog wear a collar? YesNoSometimesWhen? Would your dog walk off leash? YesNoSometimesWhen? What would happen to the dog if you had to move? What is the longest this dog would be alone each day? Where will this dog spend its days? inside, outside, etc.Where will this dog sleep? Who will be ultimately responsible for this dog? If you have children, please describe their previous experience with dogs: How will this dog get exercise? How will you discipline this dog? Will you plan to obedience train the dog? YesNoHow? Obedience Classes1-to-1 TrainingVideos/BooksSeek help if problem arisesOtherAdopted Dogs - Wonderful but Less Than Perfect (Please answer all)What would cause you to reach your limit or want to return this dog? Check ALL that apply: Hair on your furniture/SheddingStains on rugsAnimal on the bedIllnessAggression towards other dogsBarkingShy with peopleBitingOther pets don't like the dogJumping upPoor watchdogWormsHousetraining ChallengesChewingVet BillsFleasTicksGrowling at guestsShy with dogsMarriageDivorceAggressive on leashCarsicknessAllergiesMovingNew childEscapingGrooming needsDiggingNot a good dog parkMy financial problemsSpouse/Partner does not like the dogHumpingDoggie DestructionNone of the aboveOTHER NOTHING. I will keep the dog until he/she is no longer alive, or I am, whichever comes first.Planning for Investments of Money and Time (Please answer all)Dogs require investment of time and money. Can you afford to provide medical care, grooming, proper diet, shelter, and exercise for this dog? YesNoLimits Are you able to make a long-term commitment to care for this dog? YesNoLimits If a behavioral challenge arises, will you seek help from the trainer we recommend? YesNoWould you consult and pay for a trainer or behaviorist if challenges develop? YesNo FOR ADOPTING FAMILIES: PLEASE READ EACH STATEMENT CAREFULLY AND CHECK EACH BOXI agree to the following: I agree under no circumstance will this dog or any other in my possession by chained or tethered for any period of time. This doesn't refer to walking the dog on a leash.I promise that no dog will live outside in a kennel or be restricted in my home but will be part of my family and enjoy activity both indoors and outdoors.If my adopted dog is aggressive with other dogs I will not allow it to fight with other animals or run free to play with other animals in a dog park or any other similar public place. If the dog shows signs of human aggression, I promise to notify Rogue Rescue and take whatever action necessary to correct behavior including training.If adopting a Pit bull Terrier or mix, I will NEVER leave the dog outside unattendedI will provide regular veterinary care by a licensed vet for this dog including year round heartworm and flea prevention for the remainder of this dogs' life. Heatworm is transmitted via a single mosquito bite and is prevented by a monthly prevention. There are several different options that you can discuss with your vet.If your current dog is not on annual heartworm prevention, the adoption will NOT be approvedProof of the initial wellness vet visit and heartworm prevention after the adoption is finalized will be required.I give Rogue Rescue & Sanctuary permission to use any pictures of our family and/or dogs in marketing materials or other uses as Rogue Rescue sees fit.I acknowledge that Rogue Rescue retains the right at anytime to call any vet, vet hospital, reference, friend, family member etc to check on a dog or to get a dogs vet records. *AgreePLEASE NOTE: By submitting this form, you are agreeing to the terms defined above Spay & Neuter AgreementFor puppies who are adopted before they are spayed or neutered, we will require a $25 refundable fee. If you do not drop off your puppy or pick up your puppy at the designated time before and after their spay or neuter, the fee will not be refundable. *I agree to the Spay & Neuter Agreement For Adopting Families: I will never trade, giveaway, or lease the adopted animal(s) to any person or organization without first notifying Rogue Rescue, and I am legally obligated to return the animal(s) to Rogue Rescue if such a transfer is not approved. Should a representative of Rogue Rescue ask to see the animal(s), reasonable access will be granted. If it is determined that the animal(s) is not properly cared for, the animal(s) may be reclaimed by Rogue Rescue. Further, I agree to pay any reasonable expenses including legal fees that may be incurred by Rogue Rescue in the event that the adopted animal(s) placed into my custody are reclaimed by Rogue Rescue. This application remains property of Rogue Rescue. I take full responsibility by signing this adoption agreement and contract. Important Notice: Rogue Rescue makes no guarantees in reference to the health and/or temperament of the dog. The dog is adopted "AS IS" and the adopter assumes responsibility for the treatment of all existing conditions and any other conditions of physical temperament changes that may occur. While the rescuer makes every effort to place only healthy animals, the rescuer cannot guarantee the health of any animal. the rescuer shall not beheld responsible for any medical expenses which may be incurred, hereby expressly excluding any implied or express warranties, merchantability, or fitness for any particular purpose, including without limitation and warranties regarding health, temperament or whether the dog is house trained. Any liability for dog bites will be yours as soon as guardianship of the dog is transferred to you. Rogue Rescue will not be held liable for any dog bite incidents after adoption. Rogue Rescue's adoption fee is set at $175. Rogue Rescue does not refund adoption fees if the dog is returned after 30 days. If Rogue Rescue agrees, you may choose another dog if you feel there's one better suited to your home and needs. *I agree to the terms above and accept the legally binding contractDate * IMPORTANT NOTICE By electronically submitting this form, you are agreeing to any and all terms defined within the form. Furthermore, by submitting this form, you agree to the legally binding contract above. VerificationPlease enter any two digits *Example: 12This box is for spam protection - <strong>please leave it blank</strong>: