Rudy's Rescue Adoption Application

Congratulations for wanting to adopt a pet in need. This is our application, not a contract to adopt. This is the first step in the process. A successful adoption depends on finding the perfect pet for you the perfect permanent home for the pet. So please be as complete and honest as possible. We apologize the application is long, but it is necessary to get as much information as possible to make the right match.

Please read our Adoption Info Page for more information about our policies, adoption, and foster-to-adopt plans.

NOTE: We require a $25 deposit donation upon applying. You can pay via Paypal using Visa or Mastercard.

Please Note:
1) We reserve the right to perform a home visit
2) We reserve the right to approve or deny any adoption for any reason and the right to not disclose the reason
3) You must be at least 21 years of age to apply
4) The application is good for 1 year from the approval date

When answer choices are offered, please check all that apply. Please be as specific as you can.

Due to our required home visit, we only adopt to homes within the local Rochester, Buffalo, Syracuse and Utica areas. If you apply for a dog and are outside of our area you can feel good knowing your application fee will be considered a donation and will be used to help the dogs in foster care with Rudy's Rescue. If you are not sure, please send an email to shimiah@rudysrescue.info to check on your location.

*Do you understand and agree? Yes No

CONTACT INFORMATION

*Name

*Address

*City, State, Zip

*County

*Home Phone

*Cell Phone

*Work Phone

*E-Mail

DOG AND ADOPTION INFORMATION

Name of dog you are interested in adopting

If this dog is no longer available are you willing to consider others of the same breed? Yes No

Has anyone in your household ever been convicted of an animal-related charge? Yes No

How soon do you expect to adopt?

What date are you prepared to take a dog home?

How did you find out about us?

Are you applying to adopt from other rescues? Yes No

If so, what rescues?

Please understand it takes a great deal of our volunteers' time to process an application. Because of this, a $25 fee will be required with each application. Your $25 fee will be deducted from your final adoption costs. This fee helps to ensure that you are serious about adoption when applying.

Be advised most applications take two weeks to process. Once you are approved to adopt, you will be contacted via email or phone.

We require a cash, postal money order, or certified/cashier's check donation if approved to adopt.

*Do you understand this is non-refundable? Yes No

*Are you aware of the required adoption fee? Yes No

*Are you aware of the contractual requirements? Yes No

*Will you allow volunteers to investigate and/or inquire concerning the dog's circumstances after adoption? Yes No

*Do you understand that if all conditions of the adoption contract are not met our volunteers have the right to remove the dog from your home without notice? Yes No

ABOUT YOUR HOUSEHOLD

How many adults live in the house?

What is the name of the dog's primary care giver?

How many people under age 18 live in the house?

What are the ages of those under 18?

Names of other adult residents in the house:

If anyone in the house has an occupation that involves animals in any way, what is it?

Are there regular visitors to your home (human or animal)with whom your new dog will interact? Yes No

Does anyone in the house have animal allergies? Yes No

If yes, how will you avoid allergic reactions?

Do you own or rent your home? Own Rent Live With Family Other

Do you have a property owners' association? Yes No

How long have you lived at this address?

Do you have future plans to move? Yes No

If yes, how soon?

What plans do you have for this dog if you move?

If you move where dogs are not allowed, what will you do?

If military, what are your plans for your pet if you are deployed?

Do you have a fully fenced-in yard? Yes No

If yes, what is your fence height at its lowest point?

What type of fence do you have?

How big is the fenced area?

If you don't have a fence, how will you handle exercise and potty duties?

If no fence, do you plan to fence in the yard? Yes No

If so, when and what type?

Do you have a doghouse? Yes No

Do you have a dog crate? Yes No

If not, would you be willing to buy one? Yes No

Do you have a dog kennel? Yes No

REFERENCES

Please list your veterinarian and 3 personal references we may contact.

We prefer they be people who know your experience with animals.

Please notify your references that we will be calling, many references require permission from the applicant to release information.

Vet Name

Vet Phone

Please list three personal references below.

You must include name, relationship, phone, and e-mail.

*Reference #1

*Reference #2

*Reference #3

PET OWNERSHIP HISTORY

Labrador Experience

Have you researched the breed(s)? Yes No

Have you read books about the breed(s)? Yes No

Do you have family members who have owned the breed(s)? Yes No

Do you have friends who have owned the breed(s)? Yes No

What traits do you like about the breed(s)?

What traits do you dislike about the breed(s)?

Previous Cat Ownership

Have you owned any cats in the past 5 years you no longer own? Yes No

If yes, please explain:

Previous Dog Ownership

Have you owned any dogs in the past 5 years you no longer own? Yes No

If no, skip to the next section. If yes, please list description (Include name, breed, sex, age)(Example: Fido, male Lab, age 4):

Previous Dog #1

Previous Dog #2

Previous Dog #3

Current Cat Ownership:

Do you currently own any cats? Yes No

If no, skip to the next section. If yes, please list description (Include name, breed, sex, age) (Example: Molly, female DSH, age 4)

Current Cat #1

Current Cat #2

Current Cat #3

Has this cat interacted with medium or larger dogs before? Yes No

Does this cat go outdoors? Yes No

Current Dog Ownership:

Do you currently own any dogs? Yes No

If no, skip to the next section. If yes, please list description (Include name, breed, sex, age) (Example: Fido, male Lab, age 4)

Current Dog #1

Current Dog #2

Current Dog #3

Is this dog indoors when you are gone? Yes No

Other Pets:

Are there any other animals the dog will interact with? Yes No

How long have you had the other pets?

Pet #1

Pet #2

Pet #3

Are your pets spayed or neutered? Yes No

If not, why?

ABOUT THE DOG YOU WANT TO ADOPT

The questions in this section are designed to help us match the right dog with your family. The more you tell us, the better we can help find you the right dog.

If there is a particular dog that you are interested in, what about this dog sparks your interest?

Are you interested only in that dog? Yes No

If yes, skip to "What plans do you have for this dog?" If no, continue.

Must the dog be purebred? Yes No

What gender(s) are acceptable to you?

If you have a gender preference, please explain why :

Youngest acceptable age?

Oldest acceptable age?

If you have an age preference, please explain why:

What coat colors are acceptable to you?

What plans do you have for this dog? Companion Pet Obedience Agility Exercise Hiking Water Sports

How important are the following are to you?

Note: You must select an answer, otherwise your responses to these questions will show as "Not Applicable." We need this information in order to help us match you with the right dog for you.

Housebroken Not Applicable Unnecessary Trainable Preferred Essential

Crate Trained Not Applicable Unnecessary Trainable Preferred Essential

Nondestructive Not Applicable Unnecessary Trainable Preferred Essential

Good with babies Not Applicable Unnecessary Trainable Preferred Essential

Good with young children Not Applicable Unnecessary Trainable Preferred Essential

Good with cats Not Applicable Unnecessary Trainable Preferred Essential

Good with small dogs Not Applicable Unnecessary Trainable Preferred Essential

Good with male dogs Not Applicable Unnecessary Trainable Preferred Essential

Good with female dogs Not Applicable Unnecessary Trainable Preferred Essential

Will come when called Not Applicable Unnecessary Trainable Preferred Essential

Won't pull when walked on a leash Not Applicable Unnecessary Trainable Preferred Essential

Knows basic commands Not Applicable Unnecessary Trainable Preferred Essential

Won't jump up on people Not Applicable Unnecessary Trainable Preferred Essential

Won't countersurf Not Applicable Unnecessary Trainable Preferred Essential

Won't dig Not Applicable Unnecessary Trainable Preferred Essential

Rides well uncrated in car Not Applicable Unnecessary Trainable Preferred Essential

Can safely take to dog park Not Applicable Unnecessary Trainable Preferred Essential

Experienced in use of Doggy Door Not Applicable Unnecessary Trainable Preferred Essential

Will not protect food and toys Not Applicable Unnecessary Trainable Preferred Essential

Has no known medical issues Not Applicable Unnecessary Trainable Preferred Essential

OTHER INFORMATION

How much do you think it will cost you to care for this dog for one year?

Rudys Rescue requires a minimum of six weeks obedience training. Are you willing to commit to a minimum of six weeks of obedience training with your adopted dog? Yes No

How will you handle submissive urination if your dog develops it after adoption?

There is no perfect dog. Just like humans, dogs make mistakes. For example, a housebroken dog might go back to being not housebroken or the dog may get so attached to you he develops separation anxiety.

If the dog you adopt makes mistakes after he comes to your house, what will be your course of action?

How many hours will this dog be alone during the day?

Where will the dog be when you are not at home?

Where will the dog sleep?

Who will care for the dog when you vacation?

Have you ever released a pet to an animal shelter or given away an animal? Yes No

If yes, what were the circumstances?

Have you ever had a dog euthanized for any reason other than old age? Yes No

If yes, what were the circumstances?

Will you keep your dog on heartworm preventative year-round forever? Yes No

Will your dog ride in the back of a pickup truck? Yes No

Do you agree to return the dog you are adopting to this rescue if you cannot keep it? Yes No

Comments:

Please let us know any other information you wish us to consider in placing a pet with you.

*By indicating yes and submitting this form, I signify that all information given in this application is true and correct, to the best of my/our knowledge. Yes No

Rudy's Rescue and Resource Services, Inc. thanks you for taking the time to complete this application. Your interest is deeply appreciated because every dog we can place is one less that is homeless, hungry, abused, or killed. It is our dream for every animal to someday have a home.

Your $25 application fee is a non-refundable donation. If you are approved to adopt, your fee will be applied to your adoption donation. You may choose to pay through Paypal, where you can authorize payment through your Paypal account (if you have one) or through a major credit card.

You will be directed to a page with a PayPal application fee button when you complete this form.

We will start to process your application as soon as your fee is received.

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