Adoption Form

Your answers to these questions help us determine the best homes for our dogs, and the best dog for you. By applying for the adoption of a dog from Rockin P Rescue, you hereby give your Veterinarian and other references permission to disclose information to Rockin P Rescue. Signature is implied and assumed on email applications to adopt. Incomplete applications will be discarded.

Name*
First Last
Spouse/Other
Home/Cell Phone*
Email*
Enter Email Confirm Email
Address*
Street Address Address Line 2 City State ZIP Code
Employer/occupation*
Work Phone*
Work Email
Spouse/Other Occupation/Employer
Work Phone (Spouse)
Any other adults in the household?*
If yes, list occupations
Do you have any children?*
If yes, list names and ages
Personal Reference*
First Last
Phone Number for your Reference*
Email address*
Years Acquainted*
Do you have pets currently?*
If so please list breed, sex and age of each
Are all of you current pets spayed or neutered?
If your current pets are not spayed or neutered, why?
In the past 5 years have you had any other pets?*
Why they are no longer with you?
Why do you want to adopt a dog?*
What research have you done on the breed of dog you are looking at adopting?*
Describe the dog that you are looking for (age, sex, color, etc):*
Would you consider a special needs dog (blind, deaf or on medication) or a senior? Please let us know what your limits might be.*
If yes, please explain
What are your plans for this dog?*
Have you ever given up a dog?*
If yes, explain why
Who will feed, exercise, and train the dog?*
What do you plan to feed your dog?*
How do you plan to train the dog?*
Where will the dog sleep at night?*
How many hours will the dog be alone each day?*
Where will the dog be kept during the day?*
Who will take care of the dog in your absence (vacations or emergencies)?*
Are you willing to attend an obedience class?*
Do you currently have a veterinarian?*
If yes please give, Name, address and phone number
Do you live in a*
How long have you lived at this address?*
Describe your yard*
Is your yard fenced*
If yes describe fencing
If you do not have a fence, how will exercise/toilet be handled?
Do you own or rent?*
If you rent, do you have permission to have a dog?*
Rockin P Rescue requires a written statement from landlord for renter’s policy for having a dog.
Landlord’s Name, address, and phone number
May we visit your home before and after you adopt a dog?*
Is anyone in your home allergic to animals?*
How long do you plan to keep this dog?*
How much money would you consider to be a major medical expense?*
Is your entire household supportive of this adoption?*
If not or unsure, why?
How did you find out about us?*
Any additional comments?
Signature of applicant:*

By signing above I agree that the above information is true and correct and understand that this information will be included with my adoption contract and if found to be untrue at any time (even following adoption) the dog may be reclaimed at no expense to Rockin P Rescue, Inc. Further, by applying for the adoption of a dog I herby give permission to my Veterinarian, my personal reference and landlord (if applicable) to disclose information to Rockin P Rescue, Inc.
Date of Signature*
MM slash DD slash YYYY
Signature of RPR representative
Date of RPR representative
MM slash DD slash YYYY

Any additional questions can be directed to RockinPadoption@gmail.com.

rockinp.director@gmail.com

256-282-9304

Jacksonville, Alabama

Adopt A Dog

Adoption Form

(256) 282-9304

rockinpadoption@gmail.com

Mon - Fri 9:00am - 6:00 pm