Residence Street Address (Not a P.O. Box), City State, Zip:
Phone Number(s) you can be reached at:
Email Address:
I understand that I must travel to Bellbrook, Ohio to adopt the dog I am applying for. (Bellbrook is near Dayton/Xenia)
Section 4. Household Members Other Than Applicant(s)
Name:
Age:
Relationship:
Name:
Age:
Relationship:
Name:
Age:
Relationship:
Name:
Age:
Relationship:
Do children visit in your home?
If Yes, ages and frequency:
Is anyone in the household allergic to dogs or cats?
Are all household members in favor of adopting a dog?
Section 5. Dwelling Information
Type (i.e., House, Apartment, Condominium, Mobile Home):
Rent or Own?
If Rent, Landlord Name and Phone Number:
Section 7. Pets (Current and Past 3 Years)
Have you ever owned a dog as an adult?
Do you currently own any dogs?
Do you currently own any cats?
Please list all dogs and cats owned currently. If you have more pets than room allowed on the form, please describe in the comments section following.
Pet Type (Dog or Cat)/Breed:
Age:
Gender:
Spayed or Neutered?
Comments (or additional pets):
Did you have any pets in the past 3 years that are no longer with you? If yes, please explain:
Do all of your current pets get along well with other animals? If no, please explain.
Do all your pets receive regular veterinary care and are they up-to-date on vaccinations?
I understand that I may be asked to provide Veterinary Reference Information before my application is approved:
How Did You Find Us?:
Additional Comments:
I understand that dogs placed by Purebred Rescue Organization of Ohio, Inc. have received routine medical care and vaccinations, and have been spayed or neutered. I understand that I will be asked to give a non-refundable adoption donation to adopt dog.
I have answered all the above questions truthfully to the best of my knowledge. I understand that if, for any reason, I can no longer care for or keep the dog, I must return it directly to a Purebred Rescue Organization of Ohio, Inc. volunteer, and I will sign all necessary papers for the surrender of the dog. I hereby make application to Purebred Rescue Organization of Ohio, Inc. to have my name added to an appropriate waiting list for the purpose of giving a dog a permanent home. I understand that it may be important for me to be available for an interview by phone or in-person.
A $100 non-refundable deposit is required if you request us to hold a specific dog for you until adoption. Refunds will only be made if the dog requested is determined to be inappropriate for your home. A deposit can only be accepted after you have completed the application process and have been approved.
NOTICE: Your application will be retained specific to the dog or breed of dog you applied to adopt. We are all volunteers, so you may or may not be contacted as a result of your application. We will select the home that is best suited for the dogs in rescue. We do not contact all applicants.
I understand the adoption fee is non-refundable and is a donation to Purebred Rescue Organization to fund veterinary expenses, dog food expenses, and ongoing care of the dogs that are in the care of Purebred Rescue Organization.
