Application

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APPLICANT/CO-APPLICANT INFORMATION

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Are you interested in adopting or fostering?

AdoptingFostering

Primary Adopter's/Foster's Name (First, Middle, Last):*

Primary Appliocant's DOB:*

Primary Applicant's License Number:*

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:*

Cell Phone Number:*

Co Applicant’s Phone Number:

Your Email:*

Co Applicant’s Email:*

What is the best time of day to reach you?

Are you aware of your local ordinances for the number of pets allowed?

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FAMILY/HOUSEHOLD INFORMATION

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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:

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"):*

Email Address (if this does not apply to you, please type "N/A"):*

Do you have a Home Owner's Association (HOA)? If this question does not apply to you, please write "N/A".*

YesNoN/A

If yes, please fill out the HOA's contact information below. If not applicable, please write "N/A". *

HOA's Name:

HOA's Phone Number:

HOA's Email (If Available):*

Does your homeowners or rental agreement have restrictions on size or breed?

YesNo

Do you have an ESA? If an ESA is in place you will be requested to send a copy and your written permission to confirm the validity with the prescribing Doctor.

YesNo

Have you ever been convicted of a crime? If yes, please explain.

YesNo

Name of Employer:

Length of time at employer:

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NEW PET INFORMATION

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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

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EXSITING/PAST PET INFORMATION

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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

Is your current dog on Heartworm medication? If so, what kind?

YesNo

Have you heard of the “Two Week Shut Down” introduction method?

YesNo

Are you open to our suggestions on introducing your new pet?

YesNo

How long do you feel is appropriate to let your new dog adjust to his/her new house?

What do you walk your dog on?

Prong CollarChoke ChainShock CollarFlat CollarMartingale CollarHarness

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?

Do you have an invisible fence?

YesNo

If yes, do you use it with current pets?

If no current pets, do you plan on using it with your new pet?

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?

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REFERENCES

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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):

Please be sure to check your email and/or spam for an application confirmation from [email protected] This confirmation will be received within a few hours of application submission. Thank you!