MID-AMERICA BULLY BREED RESCUE ADOPTION APPLICATION

Please fill out the application form honestly and completely. We cannot process incomplete applications. Though the application is one step in our adoption process, it is the first opportunity we have to get to know you and it is an important part of our being able to make the best adoption match. YOU MUST BE 21 YEARS OF AGE TO APPLY. Current adoption fee is $225.00.

Date: *

First Name: *

Last Name: *

Street Address: *

City: *

State: *

Zip Code: *

Email Address: *

Phone Number: *

Work Phone:

Occupation: *

Tell us your age: *

By checking YES, you agree that the dog will not be used for any illegal activities nor found at any time in a municipality where the breed is illegal. *

Yes

By checking YES, you agree that the dog is to be kept as a house pet. It shall not be used for medical or any other experimental purposes. *

Yes

Please provide the name of the dog(s) you are interested in adopting.

Choice (1): *

Choice (2):

Choice (3):

Do you prefer a male or female?

Male

Female

Either

Do you prefer an adult or puppy?

Adult

Puppy

Either

Do you have a color or weight preference of your new pet?

Describe your yard and fence: *

Do you own or rent your home? *

Homeowner

Renter

If you are renting, please provide Landlord's name and phone number. We cannot process your application without this information. *

Do you know what Breed Specific Legislation is? *

Tell us in a few words what you know about Breed Specific Legislation: *

Tell us how you feel about Breed Specific Legislation: *

Do you have Breed Specific Legislation in your city? If so, please describe the restrictions or ordinance: *

Tell us about the members in your household. List all household members including their age, sex and relationship to you. (Example:. Mary, 12 years old, daughter) *

What other pets do you currently own? Please be specific with AGE, SEX AND BREED. *

Tell us about the pets you have owned in the past: *

Have you ever had to rehome a pet? If so, please explain the circumstances: *

What traits would you find unacceptable in your new pet?

What steps would you take to correct unwanted behavior? *

What circumstances would prevent you from keeping a dog for the rest of its life? *

What will you do if you cannot keep your dog? *

Are your current pets spayed or neutered? *

Yes

N/A

If your pets are not spayed/neutered please tell us why: *

Where are your pets kept while you are at work or when you leave the house?

How many hours each day will your new pet be home alone? *

Where will your pet be kept at night? *

Do you travel for business or vacation? *

Yes

If yes, who will provide for your animal(s) while you are away? *

What kind of activities do you or will you do with your pets for fun and/or exercise? *

What restrictions would you place on your dog's interaction with children? *

What restrictions would you place on a child's interactions with your dog? *

Of all the breeds available, why are you interested in the dog(s) you have listed? *

Please describe any experience you have had with the breed of the dog you are interested in adopting: *

Have you thought about and are you prepared to deal with the discrimination that may come from owning a bully breed of dog, i.e. homeowners insurance, neighbor relations, community bias? *

Are you prepared for the financial responsibility that comes with owning a dog? *

Yes

Please supply the name and phone number of your current veterinarian: *

Please supply the name and phone number of an employer, friend or someone NOT related to you that can attest to your character: *

Are you willing to travel to meet your new pet? If so, how far? *

Please provide any additional information you would like us to know about your home, family and why you are applying for a rescue dog: *

How did you hear about MABBR? *

Press submit only once. It may take a few moments for the application form to load. You will be redirected to a confirmation page when your application is submitted.

Thank you for your interest in an MABBR Incredi-Bull!