Riverbend Jail Dog Adoption Application

Riverbend Jail Dog Program Adoption Application
Thank you for your interest in our dog and program. You must be at least 18 years of age to apply. We do not adopt dogs into homes with children under 4 years of age. Children 4-8 are considered on a case-by-case basis. Please complete the application by answering all questions. Incomplete applications will not be processed. If your application is approved, you will be notified via email within 72 hours from the time we received it. We will then contact you to schedule a telephone interview which should include all adults in the home. We reserve the right to decline any applicant, if, in our opinion, the home situation is not compatible with the needs of our dog. It is important that the dog and home/family are a good match. Home checks are conducted prior to placement. Adoption fees are non-refundable and are paid at the time of adoption.
Name of the dog you are applying for:
Today's Date

MonthDayYear
Adopter's Full Name*

First NameLast Name
Date of Birth

MonthDayYear
Primary Phone Number*

Area CodePhone Number
Alternative Phone Number

Area CodePhone Number
E-mail
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
I live in a:

housecondo/townhomemobilehone/trailerapartmentOther
Describe your household

Quiet and calmAverage noiseBusy and noisyOther
Describe your neighborhood and street

Country/QuietTown/AverageCity/busyOther
Employer and Occupation:
What is your regular work schedule and days off?
Please provide a description of your dog experience.
Do you have any upcoming travel, vacation, or busy schedule in the next 6-10 weeks?

YesNo
Number of adults (18+) living in the household:
Number of children (18-) living in the household:
Age and gender of children living in your home under the age of 18
If you have children please describe their experience with dogs.
If you currently have no children, do you plan on having children in the future, or do young children (under 10) visit your home frequently?
Who else lives with you either on a part-time or full-time basis?
Is every adult in the home in favor of adopting this dog?
Is anyone living in the home allergic to dogs/dog hair?

YesNoUnknown
Who will be the primary caregiver for your new dog?
Who will care for your dog if you become unable to do so temporarily or permanently?
Do you have a pool?

YesNo
Do you have a doggie door into your home?

YesNoNo, but willing to get one
Do you own or rent?
Renters: Does your landlord permit you to have pets?
Renters: Does your landlord have any breed or weight restrictions? Yes or No. If yes what are the restrictions?
Renters: Landlord's name and phone number:
Do you have a fully fenced yard? This means a yard which is completely enclosed in such a manner as to contain dogs on the premises so they cannot leave the yard.

YesNoOther
Type and height of your fence.
If you do not have a fully fenced yard, when outside, your new dog will be:

In a pen or kennelTether, runner, chainDog will be expected to stay in the yard on their ownElectric fenceOther
Please describe all current pets in your household. (species, name, age, gender): If you have no pets please indicate none. This should include any pets in the household that belong to someone other than you.
Are all of your dogs/cats spayed or neutered?

YesNoI have no pets
If they are not all spayed/neutered, please explain why.
Do your current cats/dogs have a current rabies vaccination?

YesNoI have no pets
If your dogs/cats do not have a current rabies vaccine, please explain why.
Are your dogs kept on heartworm preventatives?

YesNoI have no pets
If you have pets, where do you obtain heartworm preventives?
My current dogs are kept when I am home.

In the houseOutsideGarageI have no petsOther
My current dogs are kept when I am not home.

In the houseOutsideGarageI have no petsOther
List any any other pets you have had in the past 5 years, who are no longer with you and describe what happened to them? Please include the pet's name, species and gender. If you have had no pets of any kind in the last 5 years, please indicate "None"
Have you ever sold or given away any of your pets - or surrendered any pet to a shelter or rescue organization?

YesNo
If you answered yes above, please explain the circumstances.
What traits are you looking for in a dog? Please be specific as this helps us find the best fit for your home and lifestyle.
What size dog do you want when the dog is full grown?

Small (20 lbs or less)Medium (20-50 lbs)Large (50-75 lbs)X-Large (80+ lbs)
Name of past and current primary veterinarian:*
Past/current primary veterinarian's phone number: Please contact your vet and give notice that we will call.
What name is the account listed under?
If you do not have a previous pet with veterinary history, please provide the name and phone number for at least 2 personal references you have known for more than 1 year. They should be either a coworker, supervisor or friend who have been to your home. References may not be related to you or anyone you live with.
Please explain where your new dog will be when you are home.
Please explain where your new dog will be kept when you are not home.
Where will your new dog sleep?
How long will your dog be alone at a time?

0-3 hours3-4 hours4-6 hours6 or more hoursOther
What daily exercise will you provide for your dog?
What brand of dog food will you feed your dog?
What is your expectation of the routine annual cost of owning a dog?
This new dog will be

a companion for me.a gift for someone in my household.a gift for someone outside of my household.a companion for my current petGuard/securityOther
Are you willing and able to give your new dog up to 3 months to fully adjust to the new home, family and routine?

YesNoOther
How did you hear about our program?
Have you or anyone residing in your household ever been accused, charged or convicted of animal neglect, abuse or cruelty?

YESNO
I agree to provide this dog with a collar and an identification tag to be worn at all times. I agree to keep this dog on monthly heartworm, flea and tick preventives and to comply with all local and state laws regarding rabies vaccinations. I agree to keep this dog on leash when on public streets, parks, etc and never transport this dog in the back of an open truck without a proper safety harness/crate. I agree never to leave this dog inside a hot vehicle. I agree never to leave my dog unattended with young children and I will spend the time and resources necessary to properly care for this dog for his/her entire lifetime.

Yes, I agree with all conditionsNo, I do not agree with all conditions
Please leave additional comments/concerns here
We generally reply to adoption applications by email. Is this agreeable to you?

YesNo

Riverbend Jail Dog Program Adoption Application