First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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Email*

Home Phone

Work Phone
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Cell Phone*

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New Training Policy: Effective April 1st, 2016. All dogs under 1 year will now have an adoption fee of $200. The adopter has three months to complete a training course of their choosing and submit the training certificate to Rescue Rovers to receive a $50 training refund. WHY ARE WE MAKING THIS CHANGE? Training has been shown to be the SINGLE MOST IMPORTANT ACTION that keeps a dog in his or her “forever” home. Training builds a mutual bond, enhances the partnership and enriches the relationship you share with your dog. Is there anything better? A trained dog is a fully participating member of the family—what a gift for all of you!

Are you applying for a specific dog?

What is the dog’s name and breed?

Is this dog for*
Choose one: You Family Another Person

Why do you want a pet? *

Please explain what you are looking for in a pet *

Desired dog size

Activity Level

Age

How many people live in your home?*
Choose one: Just me 2 3 4 5 6 7 8+

Please list the members of your household - include their relationship and age:*

Do children or grandchildren visit on occasion?

Is any one in your home allergic to any pets?

Your household is

Do you

Does your home have a yard?

Are you bound to the terms of an HOA, city ordinance or other regulation as to number of pets, breed, age, size, etc?

Please list your landlords name and phone

Where will you keep your pet during the day?

Where will you keep your pet during the night?

How many hours in a day will your pet be home alone?

The pet I adopt must (check all that apply)

I’m prepared to train my new pet for

Who will be your new pet(s) primary caretaker*

I am willing to spend up to the following amount for treatment of a pet:

Please provide a list of current and past animals. Include type and ages, how long you had them, where did you get them and why they’re no longer with you.*

Are they current on vaccinations (including rabies)?

Are they spayed or neutered?

Are they licensed?

Under what circumstances would you give up a pet? *

Have you ever had to give up a pet? If yes tell us why and what did you do.*

Name of your veterinarian*

How did you hear about Rescue Rovers?*
Choose one: Adopt-A-Pet Facebook Friend/Co-Worker KSL Other Petfinder

General Comments/Requests

Rescue Rovers assumes no liability in having knowledge of city,county or state regulations regarding the number of pets allowed per household. Adopter is responsible for researching ordinances for the city/county in which they reside prior to adopting from Rescue Rovers. If adopter is found out of compliance by city/county officials, they must return the adopted dog to Rescue Rovers immediately with no refund due.

I am at least 18 years old. All of the information I have given above is true and complete. Should an unaltered dog be placed with me, I agree to have it spayed/neutered within one month of adoption. This dog will reside in my home as a pet and will not be strictly an outdoor pet. I will provide it with adequate food, water, shelter, training, affection, and medical care. I am able and willing to spend the time and money necessary to provide training, medical treatment and proper care throughout the entire life of the dog. I understand that Rescue Rovers Dog Adoptions is not responsible for the accuracy of information received about the temperament, habits, or physical conditions of dogs available for adoption. I understand that it is my responsibility to see and evaluate the dog myself before agreeing to adopt it. I will not relinquish ownership, abandon, or dispose of such dog in any way. If I cannot keep him or her, I will turn the dog over to Rescue Rovers Dog Adoptions I do not expect reimbursement if this happens. I am in full agreement with these terms of adoption. Rescue Rovers Dog Adoptions is not liable for any damage, accident, or injury resulting from the placement of a dog into my household.

Please provide your electronic signature and date*