First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
 - 

Email*

Work Phone
x

Cell Phone

Alt Email

Text/Pager Email

If you are interested in adopting, which animal are you interested in? Many of our animals receive multiple applications, so please include a second choice. If you will not consider a second choice, please mention that here. If you would like to foster, you may leave this question blank.
Choose an animal: Admiral Aran Astro Bella Blue Boscoe Bumper Butchey Carson Claus Cleopatra Conley Cookie Monster Delta Dawn Denim Diamond Dodson Dolly Dunson Edward Emma Frank Gemma Gracie Gus Hank Harry Neil Heath Heloise Holly Homer Ivy Jade Jamey Jesse Jubi Kimbra Laurel Leia Lexi Lillie Mabel Malcolm Meeka Murray Onyx Pattie Poppy Quavo Roada Rosa Sasha Seth Solomon Sophia Stormy Tucker Unlisted Dog Vin Diesel Waffles

Who is your second choice? If you will not consider a second choice, please mention that on your application.
Choose an animal: Admiral Aran Astro Bella Blue Boscoe Bumper Butchey Carson Claus Cleopatra Conley Cookie Monster Delta Dawn Denim Diamond Dodson Dolly Dunson Edward Emma Frank Gemma Gracie Gus Hank Harry Neil Heath Heloise Holly Homer Ivy Jade Jamey Jesse Jubi Kimbra Laurel Leia Lexi Lillie Mabel Malcolm Meeka Murray Onyx Pattie Poppy Quavo Roada Rosa Sasha Seth Solomon Sophia Stormy Tucker Unlisted Dog Vin Diesel Waffles

If you selected "Unlisted Dog" from the above questions on which dog interests you, please tell us why. Also, if you do not have a second choice, please state that here.

Please provide your full name (First/Middle/Last): *

Date of birth of primary applicant (month/day/ year): *

What is your occupation?*

County in which you reside:*

Co-applicant's full name (First/Middle/Last), and maiden name and/or any aliases *

Relationship to Primary Applicant

Date of birth of co-applicant (Month/day/year):

Occupation of Co-Applicant:

Work Phone of Co-Applicant

Cell Phone of Co-Applicant

Email Address

Additional Email Address

Provide information for all adults and children in the household (FULL NAMES, AGES, IF OVER 18 PROVIDE DATE OF BIRTH, and relationship to applicant) and do you expect any change in the household? (new baby, etc.)

Have you ever been convicted of a crime? If yes, please explain the nature of the crime and the date of conviction and disposition. Conviction of a crime is not an automatic disqualification for volunteer work.*

Do you have any issues allowing a Reach Out Rescue representative to come to your home for the visit prior to or after the adoption? If yes, please explain.

Does anyone in the household have an allergy to dogs? If yes, who? If so, describe how will you handle the situation? If a visitor is allergic to the pet, how will you handle it?

Does anyone in the household smoke?*

Do you own or rent your home, or live with relatives? Describe where you live (single family house, condo, townhouse, apartment, dorm, or another type of housing).

Are there any restrictions on the breed or size of dog where you live? Provide the landlord, townhome association, or HOA head name and telephone number to allow us to verify their requirements.

How long at current address?If less than 5 years, please provide ALL previous address(es) in the past 5 years. Include street address, City, State, Zip and County in which you lived. How long at previous address(es)?

Do you plan to move in the foreseeable future? If yes, when? If yes, explain what will happen to the dog.

If there is a death or you became incapacitated or other unforeseen circumstances arose in your life where you were unable to keep your dog, what would you do with the dog?

Do you work away from home? Describe how long you are away with work and/or school and if anyone is stay at home. *

Why do you want to adopt a dog and what are the characteristics of your new family member? Describe the activity and exercise level, socialization requirements(people and animals) and other attributes that you want in a dog, and describe who your dog will be in contact with (children, seniors, other dogs, cats, etc).

Where will your dog live? Describe where the dog will be when you're home, you're not home, you're asleep, outside. If you will be crating, describe where the crate will be and how many hours a day the dog will be crated.

Is your yard fenced? If yes, please describe type and height of fence.

Who are your current and past pets? Provide name, type of pet, breed, size, male/female, spay/neuter, age and if you still own or what has happened to the pet.*

Who will be primarily responsible for feeding, grooming, pooper scooper, walking, training, and vet visits for the new dog? Provide information on the following used for current or past pets. 1)Food brand and feeding schedule 2)Type of collar and/or harness 3)Heartworm Preventive - how often

Have you ever had to give up a pet, had a pet stolen, or hit by a car? If yes to any of these, explain the circumstances.

Have you ever adopted from a shelter/rescue organization? If yes, which one. Have you recently applied to adopt from another shelter/rescue organization? If yes, which shelter(s) and status of application.

Do you have experience with dog training and where do you plan to take your dog for the required training? Please describe. Reach Out Rescue can provide recommendations.

What are you willing to do to deal with behavior concerns with the new dog, how long are you willing to work with the dog, and is there any behavior that you cannot deal with? As we all know new dog takes time to adjust and can come with some behavior issues, (jumping on furniture, jumping an indoor fence/gate, jumping on people, chewing on shoes/furniture, playful nipping or mouthiness, biting, barking/howling, guarding, digging, shedding).

Do you have the ability to separate the dog from your pets should it be necessary?

How often do you visit the vet with your dog and how often do you give vaccines and test for heartworm and lyme disease?

How much do you expect to spend for maintenance for your dog in a year and how will you handle an unexpected vet cost over the normal budget?

Please provide 3 nonfamily personal references who are familiar with your family and pets. One reference should be a neighbor. Please provide phone numbers. References can include pet sitter, groomer, etc. Please do NOT include your vet or family members.

Who is your current veterinarian? Please provide phone number. If you do not have a current one, please provide name and phone number of last veterinarian and the pets names that were seen there.

Would you be interested in volunteering for Reach Out Rescue & Resources? Areas where volunteers are needed include processing applications, making telephone calls, home visits, and fostering.

How did you hear about RORR?

Do you understand the information we receive during the approval process is confidential and we cannot give details to the applicants if they are denied?*

PLEASE READ CAREFULLY: By typing your name below (which is considered electronic signature), I certify that I understand that adopting a dog or puppy is a serious responsibility. A dog you adopt today will likely be a part of your family for the next 12 to 15 years. A dog makes considerable demands on your time and resources. As a dog owner, you will need to spend time training, socializing, grooming, feeding, scooping poop, exercising and playing with your dog each day. Dogs that have not had training need even more time and socialization. All dogs require regular medical care. Some dogs require special food or medications. Some dogs require regular professional grooming. Vet bills, pet sitting and vacation boarding fees may add considerable expense to your family budget. By signing below, you are stating that you are prepared to accept the personal and financial responsibility of owning a dog. I also certify that the information provided on this application is true and I recognize that any misrepresentation of facts will result in losing adoption privileges. I further understand that the adoption of this pet may be delayed until information can be verified. I authorize investigation of all statements in this application, understanding that veterinarians, landlords and personal references may be contacted, and I authorize the persons/entities listed above and/or their personnel to disclose to a representative of Reach Out Rescue & Resources information that they possess regarding myself, my family, and the treatment and services of my current or former pets. *