Ruff Start Rescue - Adoption Application

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Please read the entire application and fill it out completely. All information will be kept confidential. Ruff Start Rescue reserves the right to refuse any application. Due to the high volume of applications we receive, we do not guarantee a response if we feel, for whatever reason, that we will not be able to match a dog to your family. Submission of an application does not guarantee the adoption of a dog.

Adoption Process

Have you read the Adoption Information page and understand the steps involved in the adoption process? Yes
No

Personal Information

Name:

Street address 1:

Street address 2:

City:

State:

Zipcode:

Home phone #:

Work phone #:

Cell phone #:

Email address:

Re-enter email address:

Place of employment:

Length of time with employer:

Weekly hours of employment, incl. commute:

Are you in the military?

Yes
No

Home Information

What type of home do you live in?

Do you own or rent your residence?
Own
Rent

If you rent, what Type/Size pets are allowed?

Landlord's name:

Landlord's phone #

Do we have permission to contact your landlord?

Yes
No
n/a

If you've rented your current residence for less than 1 year please provide the name and phone # of your previous landlord:

What is the size of your lot?

Do you have a yard?

Yes
No

Is your yard fenced in?

Yes
No
n/a

What type of fence is it?

How high is the fence?

Does the fence have any holes or gaps?

Yes
No
n/a

Is the fence attached to the home?

Yes
No
n/a

Does the fence belong to you, your neighbors or your landlord?

Self
Neighbors
Landlord
n/a

If you do not have a fence do you intend to install one?

Yes
No
n/a

If so, when and what kind?

Family Information

How many ADULTS live in your home?

Please list the names, ages and relationship of each adult in the house and how they will be involved with the dog:

Are there CHILDREN in the household?
Yes
No

If so, what are their ages?

For whom are you adopting the dog?

Is anyone in your household allergic to dogs?
Yes
No

If so, please explain:

Is EVERYONE in your family in agreement about adopting a dog?
Yes
No

Adoption Information

Which dog(s) are you interested in?

What breed/type of dog are you interested in?

Preferred gender:

Male
Female
Either

Preferred Age Range:
(check all that apply)

Puppy: up to 1 year old
Young Adult: 1-3 years old
Adult: 3-7 years old
Senior: over 7 years old

Why do you want to adopt a dog?

What do you think are the most important responsibilities in owning a dog?

Have you submitted an application with another organization at this time? Yes
No

If so, which organization?

Have you ever had an adoption application declined? Yes
No

If so, why?

Would you consider a dog with one of the following special needs?
(Check all that apply)
Senior dog
Simple medical Issues
Extensive medical issues

How much training would you be prepared to do with a dog?

None to minimal
Simple: jumps on people, pulls on leash, etc.

Extensive: no basic training, destructive, etc.

Are you willing to housebreak a dog?
Yes
No

Please NOTE any questions, concerns or requirements regarding this:

If you are applying for a puppy/dog that is not housetrained, how will you housetrain the dog?

If a behavioral problem arises, what steps will you take to work with it?

Describe the kinds of personal situations where you might have to return your adopted dog; i.e. job change, birth of children, move, marital change:

Who will be primarily responsible for feed and taking the dog outside?

Who will take care of the dog in the absence of the primary caretaker?

What reading or other steps have you take to prepare for a new dog?

Will you take the dog to obedience training?

Yes
No

If so, where?

Would you be willing to obtain an open wire crate, if recommended?
Yes
No

Do you have a tie-out or runner for the dog?
Yes
No

Describe the circumstances in which you would Walk/Exercise a dog on leash:

Describe the circumstances in which you would Walk/Exercise a dog off leash:

How often will you exercise the dog and for approximately how long?

How many hours will the dog be left unattended?

When you are home where will the dog be kept?

When no one is home where will the dog be kept?

Where will the dog sleep?

Do you have a dog door?

Yes
No

If not, do you plan to install one?

Yes
No
n/a

How often do you travel?

What will you do with the dog when you travel?

If you move, what will you do with the dog?

Have you considered the extra expenses assoc. with a new dog, such as vet care, food, supplies, toys, training, etc.? Yes
No

Please explain:

Would you be willing to travel to pick up you dog?
Yes
No

If so, what is the farthest you would go?

Are you willing to have a Ruff Start Rescue representative visit your home prior to adopting?
Yes
No

Are you aware that Ruff Start Rescue requires all dogs/cats in the home to be Spayed/Neutered?
Yes
No

Are you aware the adoption fee is $450 for mixed breed and $550 for pure bred (non-refundable donation)?
Yes
No

Are you familiar with local animal control laws?
Yes
No

Pet Information

What kind of pets have you owned in the past?

Describe the pets you currently own:

Pet #1

Name:

Type:

Age:

Sex:

Male
Female

Is the pet Spayed/Neutered?

Yes
No

Preventatives used/
treatments given:

Where is this pet kept primarily?
Indoors
Outdoors

If outdoors, please explain:

When did you obtain this pet?

How did you obtain this pet?

Comments about this pet:

Pet #2

Name:

Type:

Age:

Sex:

Male
Female

Is the pet Spayed/Neutered?

Yes
No

Preventatives used/
treatments given:

Where is this pet kept primarily?
Indoors
Outdoors

If outdoors, please explain:

When did you obtain this pet?

How did you obtain this pet?

Comments about this pet:

Pet #3

Name:

Type:

Age:

Sex:

Male
Female

Is the pet Spayed/Neutered?

Yes
No

Preventatives used/
treatments given:

Where is this pet kept primarily?
Indoors
Outdoors

If outdoors, please explain:

When did you obtain this pet?

How did you obtain this pet?

Comments about this pet:

Veterinarian Information

Please provide information on the last two veterinary offices/Animal hospitals where your pet(s) have received care

Veterinarian #1

Name:

Phone #:

Pet Owner's name:

Pet(s) seen:

Date of last visit?

Veterinarian #2

Name:

Phone #:

Pet Owner's name:

Pet(s) seen:

Date of last visit?

If applicable, please list the names and phone numbers of any other vets you've used over the last 10 years:

Please provide the name, address and phone # of the vet you intend to use for your new pet:

What kind of veterinary care do you intend to provide?

There are many ways to make a difference in lives of our wonderful rescue dogs:

Perhaps you can donate a $17.50 dog bed to help our rescues that are still in the kennel or foster homes?

...or consider making a one-time PayPal/credit card donation to help us help our animals!

...or consider making a monthly PayPal/credit card donation to help us help our animals!
...and, lastly, you can help us out with much needed supplies, treats and toys by checking out our Amazon Wish List

Ruff Start Rescue

PO Box 202
Thornwood, NY 10594

Email: ruffstartrescueny@gmail.com

RSR Emergency Medical Fund

Beautiful Harvey can to us riddlesd with buckshot. He's just one example of the many dogs that come to us requiring medical attention. Fortunately, Harvey was helped and went on to a wonderful home!

Please consider making a special tax-deductible donation towards Ruff Start's Emergency Medical Fund to enable us to help more dogs like Harvey. Every dollar helps!

Thank you for all of your support! Love and big, wet kisses from the RSR doggy family!

Photo by Lisa Jakobson Photography