911RUFF.org Adoption Application Form

Thank you for your interest in our dogs. We would appreciate your answers to the following questions so we can best find the right canine for you. Submission of this application does not guarantee that you will receive a dog.

Date / MM / DD YYYY
Name * First Last
Age
Email *
Phone * - (###) - ### ####
Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Are you married? Yes No
If you are not married, do you have a significant other? Yes No
Spouse/Significant Other's Name and phone number
Spouse/Significant Other's Age
Are you self employed? Yes No
Employer
Department
Employer Phone - (###) - ### ####
Spouse/Significant Other's Employer
Spouse/Significant Other's Department
Employer Phone - (###) - ### ####
If military, what is your rank?
Number of Children and Their Ages
Is everyone in your household in agreement on adopting a canine? Yes No
If no, who is not?
Why?
Besides yourself, who all resides in your home? Please include their names and ages.
Do they have pets? Yes No
Whose name is the lease/mortgage in?
How long have you lived at your current address?
If less than 2 years, please list your previous addresses including city and state for the last 10 years:
Please indicate which best describes your current living situation: (Check all that apply) Single Family House Town House Apartment Mobile Home Condo
What type of environment? City Suburban Rural
Do you? Rent Own Live with Parents Live with Relatives Live with Friends
If you rent, does yoru lease permit dogs? Yes No N/A
Name of Your Landord/Complex Manager
Landlord/Complex Manager Phone - (###) - ### ####
How did you hear about RUFF?
Does your home have a yard? Yes No
Does your home have a doggy door? * Yes No
If not, are you willing to get a doggy door? If you already have one, please select "Yes." * Yes No
If yes, when will you put it in? / MM / DD YYYY
Do you have a fence? Yes No
Select Fence Type: Wood Privacy Chain Length Woven Wire Iron Other
If "Other", what is the fence type?
Do you have or will you have a virtual fence? Yes No
Select Fence Height: 3ft 4ft 5ft 6ft 7ft 8ft
Select Fence Ownership: Personally Owned Fence Community Fence No Fence
Is this primarily for horses/cattle? Yes N N/A
Does the fence enclose: Backyard Frontyard Whole Yard Other N/A
Does the fence touch on all sides? Yes No N/A
How many gates?
Will the gate be locked with a lock? Yes No N/A
Is the fence secured underground as well? Yes No N/A
If yes, how?
If you do not have a fence, do you plan on putting one up? Yes No N/A
If yes, when? / MM / DD YYYY
What type and height of fence?
Where will the dog be kept most of the time? Inside Outside Other
Please Specify Other:
If kept outside, will you have a: Dog House Dog Run Other
If other, please explain:
Is someone home both day and night? Yes No
If not, where will the dog stay while you are gone?
Will the dog stay outside when you are at work? Yes No
How much time is spent outside per day?
How much time is spent outside per night?
There will be times that no one will be home even for a very short time (shopping, etc.) Where will your dog stay for these short periods?
Where will your dog sleep at night?
What type of food do you plan on feeding the dog?
How often will you be feeding the dog and how much?
If you have to move, what would you do with the dog?
If circumstances change and you have to move into a home that doesn't allow dogs, what would you do with this dog and any others you have?
If you are evacuated during a hurricane or bad weather, where will your dog stay?
Do you own a dog crate? Yes No
If so, what type and size is the crate?
If you do not own a crate, are you planning on getting one? Yes No N/A
If no, please explain why:
Have you ever owned a dog before? Yes No
How long did you own the dog?
How many as a child?
How many as an adult?
Where is/are the dog(s) now?
If deceased, cause of death?
Who was your vet when the dog(s) were alive? List each:
What vet clinic did they go to?
What city/state was the vet clinic in?
Vet Clinic Phone - (###) - ### ####
Why do you want a dog?
Do you want an "inside" or "outside" dog?
Do you prefer male or female? Male Female Other
Why one gender over another?
Age Range:
Size:
What dog(s) are you interested in adopting? Please list two.
Will the dog be used as a guard dog? Yes No
If yes, please explain?
What activities do you plan to do with your dog?
How many years do you plan to keep your dog?
Which vet or clinic will you be using with this dog?
Do you have any other pets? Yes No
Where did you get them?
Your current dogs, cats, or other pets' names:
First pet type? (dog/cat/other)
Breed:
Weight:
Sex:
Age:
Fixed? Yes No N/A
How long have you had this pet?
Second pet type? (dog/cat/other)
Breed:
Weight:
Sex:
Age:
Fixed? Yes No N/A
How long have you had this pet?
Third pet type? (dog/cat/other)
Breed:
Weight:
Sex:
Age:
Fixed? Yes No N/A
How long have you had this pet?
If you have more pets, continue in the box below (breed, weight, sex, age, fixed):
Are or were your other pets current on all vaccinations? Yes No N/A
Are or were (if deceased) your pets current on all vaccinations? Yes No
Is or was (if deceased) your other pets spayed/neutered? Yes No
Are or were your other pets on heartworm preventatives? Yes No N/A
What is the name of the preventative(s) you use OR used?
If you do not give your pet heartworm preventative, please explain why not?
If you do give your pet heartworm preventative, please explain where you purchase it.
Are or were your other pets on flea preventatives? Yes No N/A
What preventative did you use or do you use for flea prevention and where do you buy it?
If you do not give your pet flea preventative, please explain why not?
If you do give your pet flea preventative, please explain where you purchase it.
Your Veterinarian's Name (even if animal is deceased):
Veterinarian's Phone - (###) - ### ####
If applicable, approximate date of your current pet's last office visit: / MM / DD YYYY
List the pets you have owned in the past ten years:
Name that all your pet(s) were under at the vet's office (pet's and owner's):
What causes heartworm disease? *
If the dog that you are expecting to adopt is or was heartworm positive, are you willing to pay for the heartworm treatment? Treatment can be as much as $600.00. * Yes No
If no, please explain why not?
List any Humane Societies, Organizations, Breed or Training Clubs you are associated with or have ever been associated with:
If you have any additional information or explanations, please enter that information below:
Please provide the name, address, and phone numbers of 3 references that you have known at least 5 years that are not related to you. Please note that applications without 3 references and their phone numbers will not be accepted for adoption.

Reference 1: First Last
Phone - (###) - ### ####
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Reference 2: First Last
Phone - (###) - ### ####
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Reference 3: First Last
Phone - (###) - ### ####
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Rescued Unwanted Furry Friends (RUFF) wishes to place its dogs in loving homes with exceptional people. Our adoption contract states our expectations on the dog's care, both mentally and physically. In the case of physically, one of the factors in our decision making process is the care you provide for your present pets as well as those from your past. For this reason, we need your consent to contact your past and present veterinarians for information on the care you provided for your present and/or past pets. * I authorize RUFF personnel to contact my vet(s) for previous pet care information.
By submitting this form you certify to the following: I certify that the information provided on this form is true and correct and I am financially and physically capable of providing the care for this dog. I realize that there is a contract that must be signed at time of adoption and I am not required to adopt the dog should my application be approved and if I disagree with the contract of adoption. Adoption of the dog will show my acceptance of the contract of which a copy will be given to me at time of adoption after obtaining my signature. I realize that adoption of a RUFF dog means that I will abide by all aspects of the adoption contract and failure to do so means that I will be required to return the dog to RUFF immediately upon request. IF FOR ANY REASON YOU NEED TO GIVE UP YOUR DOG, YOU AGREE TO RETURN THE DOG TO: JANICE BROOKS - RUFF, 1003 Hwy 173 Graceville, FL 32440 (850) 863-7833 * I certify