In order to qualify for Chi-Town Pitties, Inc. foster/adoption program, the following need to be met: -Must be at least 23 years of age, and show proof of age with either a State ID or Driver's License -All current pets must be up to date with vaccinations and be spayed/neutered -If you currently rent, must provide landlord's phone number -If you have an HOA, must be able to provide HOA contact information -Must live within 50 miles of the 60189 zip code -Be an Illinois resident, we do not adopt out of state -DO NOT hit "back", application does not save. Only begin application when you have sufficient time to complete. Please Note: All fields with an asterisk * are required, and must be filled out in order to submit your application. _____________________________________________________________________________________________ Applicant/Co-Applicant Information _____________________________________________________________________________________________ Are you interested in adopting or fostering? AdoptingFostering Primary Adopter's/Foster's Name (First, Middle, Last):* Primary Appliocant's DOB:* Full names and ages of ALL additional family members in household: DOB for ALL family members over the age 18yrs of age:* Address:* City:* State:* --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code:* Primary Phone Number:* Secondary Phone Number: Your Email:* What is the best time of day to reach you? _____________________________________________________________________________________________ Family/Household Information _____________________________________________________________________________________________ What is the length of time you have been at your present address? If less than one year, please list previous address: Address: City: State: --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code: If previous address was a rental, list name and number of landlord (if this does not apply to you, please type "N/A"):* Name: Phone Number (if this does not apply to you, please type "N/A"):* Do you rent or own? RentOwn If you rent, please provide name and number of current landlord(if this does not apply to you, please type "N/A"):* Name (if this does not apply to you, please type "N/A")*: Phone Number (if this does not apply to you, please type "N/A"):* Do you have a Home Owner's Association (HOA) (if this does not apply to you, please choose "N/A")?* YesNoN/A If yes, please fill out the HOA's contact information below.* HOA's Name(if this does not apply to you, please type "N/A"): HOA's Phone Number (if this does not apply to you, please type "N/A"): HOA's Email (If Available) (if this does not apply to you, please type "N/A"):* Have you ever been convicted of a crime? YesNo If yes, please explain. Name of Employer: Length of time at employer: _____________________________________________________________________________________________ New Pet Information _____________________________________________________________________________________________ How did you hear about Chi-Town Pitties, Inc.? When were you hoping to adopt? What age group would you like to adopt/foster from? Is there a specific dog(s) you are interested in? Have you currently filled out applications with other rescues? YesNo If yes, when were applications filled out? Why are you considering a pitbull? Please list characteristics that are most important to you when choosing a pet: Why are you interested in adopting a pet? How long have you been considering adopting a companion animal? Is this your first companion animal? YesNo _____________________________________________________________________________________________ Existing/Past Pet Information _____________________________________________________________________________________________ Do you currently have any other companion animals? YesNo If yes, please list all current animals in the household; please include name, age, gender, weight, and breed: If you have other animals, are they spayed or neutered? YesNo Have you adopted a rescued animal companion before? YesNo How do you plan to introduce your new companion animal to other people/animals in the household? Have you heard of the “Two Week Shut Down” introduction method? YesNo Are you open to our suggestions on introducing your new pet? YesNo Who is or will be your veterinarian? Phone Number: Veterinarian Email (if known): Address: City: State: --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code: How much money do you anticipate on spending on your new companion animal's annual doctor visits? What would you do in the event of excessive medical expenses (emergencies and diagnosis of a medical condition)? What yearly vaccines will your companion animal receive? Does anyone in your household have pet allergies? YesNo If someone in your household does have pet allergies, how do you cope with that? If no one in your family currently has pet allergies, but were to develop them in the future, what would you do? What is the longest period of time you would leave your companion animal unattended outside? Do you have a completely fenced-in backyard? YesNo If yes, how high and what type? When you are not home, will the dog have free run of the house, be crated, or be let outside? HouseCratedOutside If the dog will be let outside, will the dog be in an outdoor dog pen, or will a chain or tie-out be used? If something else is to be used, choose "other," and please detail below. Dog PenChainTie-OutOther If "other," please explain: How will your animal companion get exercise? Do you have an outside dog run? YesNo Do you have a dog house? YesNo Do you have a training crate? YesNo Do you have a basement? YesNo Do you have a garage? YesNo Do you have a doggie door? YesNo Do you have a balcony? YesNo What are your feelings on dog parks? Do you and your current pet(s) attend dog parks? YesNo If yes, are they on leash or off leash parks? On LeashOff Leash Where will the animal companion be kept during the day? Where will your animal companion be kept during the evening? What brand of food will you feed your animal companion? What are your beliefs regarding spaying/neutering? Who will be primarily responsible for feeding/caring for your new animal companion? What do you believe is the average life expectancy of a dog/cat? What are your beliefs regarding obedience training? Have you attended a training program? YesNo If so, where did you attend? Will you be attending training with your new dog? YesNo Where would you attend training with the new dog? Have you ever had to rehome an animal? YesNo Have you ever turned an animal into an animal shelter? YesNo Have you ever had to put a pet down? YesNo Why did you have to put a pet down? What would you do with the dog in the event that you had to move? How would you handle jumping on furniture/counters/tables? How would you handle destroying/scratching the furniture? How would you handle chewing? How would you handle barking? How would you handle urinating/defecating where it is not acceptable? How would you handle being kept up all night? How would you handle excessive shedding? How would you handle it if your new animal companion ruined your favorite article of clothing? How would you handle biting/play biting? _____________________________________________________________________________________________ References _____________________________________________________________________________________________ Please provide the names and phone numbers of four references not related to you: Reference: Phone Number: Reference: Phone Number: Reference: Phone Number: Reference: Phone Number: I certify that the information I have provided is accurate and honest. Signature (First, Middle, Last):