THE MERIT PIT BULL FOUNDATION

Adoption Application
APPLICANT INFORMATION
Last Name Street Address City Phone Cell Please indicate your housing status If renting please provide your landlords name and phone number: Insurance Carrier/ Policy number: Agent name / Phone number: Other Rent Own State E-mail Address: Drivers License # First M.I. Date

Apartment/Unit # ZIP

QUESTIONNAIRE
Why do you want to adopt a pit bull type dog?

Times available for in-home interview? Do you work outside the home? How many hours a day will your pets be alone? Where would they be kept while you are away from home? Have you fostered/adopted for any other rescue or shelter? If yes, which group and contact person:

How many adults / children in your household (with ages):

Please list all current animals in your household: Name: Spayed/Neutered: Name/Sex: Spayed/Neutered: Name/Sex: Spayed/Neutered: Are your pets good with other animals? If you have cats, where do they stay? If you have dogs, where do they stay? Do you have a fenced in yard? Current veterinarians name and number: Which of the following dog training or behavior issues have you had experience with? Dog aggression Housetraining Pulling on leash Other, please list: Cat aggression Chewing Escaping from fenced area Separation anxiety Hyperactivity Resource guarding Inappropriate jumping Crate training Excessive barking YES Inside Inside YES Breed: Sex/Age: Breed: Sex/Age: Breed: Sex/Age: NO Outside Outside NO

Which of the following dog training or behavior issues have you NOT had experience with, but would be willing to work with? Dog aggression Housetraining Pulling on leash Other, please list: Cat aggression Chewing Escaping from fenced area Separation anxiety Hyperactivity Resource guarding Inappropriate jumping Crate training Excessive barking

Which of the following dog training or behavior issues are not something that you are prepared to deal with and would make you reconsider re-homing your dog? Dog aggression Housetraining Pulling on leash Other, please list: Cat aggression Chewing Escaping from fenced area Separation anxiety Hyperactivity Resource guarding Inappropriate jumping Crate training Excessive barking

REFERENCES
Please list two references we may contact:
Full Name Address Relationship Phone ( )

Full Name Address

Relationship Phone ( )

DISCLAIMER AND SIGNATURE

I certify that my answers are true and complete to the best of my knowledge and I have read, understand, and acknowledge The Merit Pit Bull Foundations waiver and liability release form. I have also read, understand, and acknowledge the policies set forth by The Merit Pit Bull Foundation. Signature Date