Page 1 of 7

Don't BULLY Me Rescue Texas Adoption Form

Don't BULLY Me Rescue
"Saving Texas Death Row Pits"
PO Box 5481
Lago Vista, Texas 78645
Email: Contact Page

CANINE ADOPTION APPLICATION

Please give careful consideration to adopting! Be sure your lifestyle allows the time, patience and expense this pet will need over the years. Adding a pet to your family is a 10 to 15 year commitment. Animals are not toys or short-term commitments and they are NOT disposable.

Procedure: Completely fill out and sign the application. You will hear back within 10 days or please assume your application was not selected. Applications that are selected will go through all necessary checks to ensure a proper home. If the adoption is approved, an adoption contract will be signed and adoption fee paid.
Adoption Fee payable to Heather Morris/Don't BULLY Me RESCUE IN the form of Money Order, Cash or Check
Date *
Invalid Input
Applicant's Information
Applicant's Full Name *
Invalid Input
Age *
Invalid Input
Co-Applicant's Full Name *
Invalid Input
Relationship to Applicant *
Invalid Input
Street *
Invalid Input
City *
Invalid Input
State *
Invalid Input
Home Phone (111-222-3333) *
Invalid Input
Cell Phone (111-222-3333)
Invalid Input
Email *
Invalid Input
Employer Name *
Invalid Input
Occupation *
Invalid Input
Employer Phone (111-222-3333)
Invalid Input
Co-Applicant's Employer Name *
Invalid Input
Co-Applicant's Occupation *
Invalid Input
Co-Applicant's Employer Phone (111-222-3333)
Invalid Input
   
Canine Information
Name of dog you are applying for?
Invalid Input
Breed
Invalid Input
How did you become aware of this dog?
Invalid Input
Why do you want to adopt a dog? *
Please choose at least one
If Gift, Protection or Other, please explain
Invalid Input
What are you looking for in a dog?
Age *
Please choose at least one
Sex *
Please choose at least one
Coat *
Please choose at least one
Color Preference
Invalid Input
Personality
Invalid Input
Health preference *
Please choose at least one
Where will the dog live? *
Please choose one
Please explain further about where the dog will live. *
Invalid Input
Are you willing to take the time to housebreak a dog, and do you understand that changing a dog's environment may cause the dog to have accidents? *
Invalid Input
If you are applying for a puppy or dog that is not housetrained, how will you housetrain?
Invalid Input
What steps have you taken to prepare for a new dog? *
Invalid Input
Have you done research on the breed of dog you are interested in? *
Please choose one
Why do you want this breed?
Invalid Input
Are you willing to obtain an appropriately sized crate if recommended? *
Please choose one
Do you plan to go to a professional dog trainer and/or obedience school? *
Please choose one
If no, why?
Invalid Input
If yes, who?
Invalid Input
If behavioral issues should arise, what actions will you take?
Invalid Input
Who will care for and exercise the new dog? *
Invalid Input
How many hours will the dog be left alone during the day? *
Invalid Input
How many hours will the dog be left alone at night? *
Invalid Input
When no one is home where will the dog stay? *
Invalid Input
Where will the dog sleep at night? *
Invalid Input
Will the dog be allowed on furniture? *
Invalid Input
Will the dog have free run of the house? *
Invalid Input
If and when you travel where will the dog stay? *
Invalid Input
If you have to move what will you do with your new dog? *
Invalid Input
Are you aware of your local ordinance concerning dog licensing? *
Invalid Input
Are you aware of your local ordinances concerning leash laws? *
Invalid Input
Have you ever been cited for any dog related ordinances? *
Invalid Input
Does your town or city have any Breed Restrictions? *
Invalid Input
If Yes, what are they?
Invalid Input
Do you agree the dog will NOT be used for fighting, breeding, illegal activities or be found at any time in a location where is presence is illegal? *
Invalid Input
Are you aware dogs can shed all year long? *
Invalid Input
Have you considered the extra expenses that will come with owning a new Dog?

The cost of owning a dog typically runs from $500 to $1500 per year for basic food, routine veterinary care, vaccinations and boarding -- but not including grooming. If a dog is injured or gets seriously ill, extra veterinary care can cost hundreds to thousands of dollars. *
Invalid Input
Have all household members met and agreed on a new dog? *
Invalid Input
Describe the kind of situations where you might return your adopted dog. *
Invalid Input
What reasons do you feel are valid for giving up a pet? *
Invalid Input
Other (please explain)
Invalid Input
   
PET AND VETERINARY HISTORY
Have you ever had to give up ownership of a pet? *
Invalid Input
If yes, please explain
Invalid Input
Do you currently have any pets? *
Invalid Input
CURRENT PETS
Pet 1
Type of pet/breed
Invalid Input
Gender
Invalid Input
Age
Invalid Input
Indoor/Outdoor
Invalid Input
This pet's veterinarian's name?
Invalid Input
This pet's veterinarian's phone? (111-222-3333)
Invalid Input
Name of person on file with vet?
Invalid Input
Pet 2
Type of pet/breed
Invalid Input
Gender
Invalid Input
Age
Invalid Input
Indoor/Outdoor
Invalid Input
This pet's veterinarian's name?
Invalid Input
This pet's veterinarian's phone? (111-222-3333)
Invalid Input
Name of person on file with vet?
Invalid Input
Pet 3
Type of pet/breed
Invalid Input
Gender
Invalid Input
Age
Invalid Input
Indoor/Outdoor
Invalid Input
This pet's veterinarian's name?
Invalid Input
This pet's veterinarian's phone? (111-222-3333)
Invalid Input
Name of person on file with vet?
Invalid Input
   
If you currently have no pets, please list pets over the past 10 years.

PAST PETS
Pet 1
Type of pet/breed
Invalid Input
Gender
Invalid Input
Age
Invalid Input
Indoor/Outdoor
Invalid Input
This pet's veterinarian's name?
Invalid Input
This pet's veterinarian's phone? (111-222-3333)
Invalid Input
Name of person on file with vet?
Invalid Input
Pet 2
Type of pet/breed
Invalid Input
Gender
Invalid Input
Age
Invalid Input
Indoor/Outdoor
Invalid Input
This pet's veterinarian's name?
Invalid Input
This pet's veterinarian's phone? (111-222-3333)
Invalid Input
Name of person on file with vet?
Invalid Input
Pet 3
Type of pet/breed
Invalid Input
Gender
Invalid Input
Age
Invalid Input
Indoor/Outdoor
Invalid Input
This pet's veterinarian's name?
Invalid Input
This pet's veterinarian's phone? (111-222-3333)
Invalid Input
Name of person on file with vet?
Invalid Input
Name of veterinarian you will use for your new pet? *
Invalid Input
Contact info for veterinarian you will use for your new pet? *
Invalid Input
   
HOUSEHOLD INFORMATION
Have all household members been around pets? *
Invalid Input
Is your residence: *
Invalid Input
If other was chosen, please explain.
Invalid Input
If you live in a Condo or Rent – Does the Association or Landlord have Breed or Size Restrictions?
Invalid Input
If you live with Parents, Friends or Rent – Do you have permission to have a dog?
Invalid Input
If you Rent please provide Name & Telephone number of Landlord.
Landlord Name
Invalid Input
Landlord Phone *
Invalid Input
How long at current residence? *
Invalid Input
If you rent and live at current residence for less than 2 years, list the name and contact info for prior Landlord.
Landlord Name
Invalid Input
Landlord Phone
Invalid Input
Is your yard fenced in? *
Invalid Input
If yes, fence type and height?
Invalid Input
Does the fence belong to you?
Invalid Input
If no, please explain
Invalid Input
Is fence attached to the house?
Invalid Input
Any Holes or Gaps in the Fence?
Invalid Input
If holes or gaps can the dog get out?
Invalid Input
If No fence, do you plan to install one?
Invalid Input
If yes, please explain
Invalid Input
Do you have Tie-Outs?
Invalid Input
Do you have Overhead Runs?
Invalid Input
Number of children in household? *
Invalid Input
Number of adults in household *
Invalid Input
Please list all members living in household
Name 1 *
Invalid Input
Age 1 *
Invalid Input
Name 2
Invalid Input
Age 2
Invalid Input
Name 3
Invalid Input
Age 3
Invalid Input
Name 4
Invalid Input
Age 4
Invalid Input
Name 5
Invalid Input
Age 5
Invalid Input
   
REFERENCES
Please provide names and contact info for two references, not related to or living with you.
Name 1 *
Invalid Input
Address 1 *
Invalid Input
Phone 1 *
Invalid Input
Relationship to You 1 *
Invalid Input
Name 2 *
Invalid Input
Address 2 *
Invalid Input
Phone 2 *
Invalid Input
Relationship to You 2 *
Invalid Input
   
ADDITIONAL INFORMATION
Please provide any additional information you would like us to know:
Invalid Input
AGREEMENT AND SIGNATURE

By signing this application I attest that the information provided is true and accurate and understand false information will result in denial of adoption. Also, if an omission or untruth is discovered after an adoption takes place, Don’t BULLY Me Rescue reserves the right to annul the adoption and reclaim the animal. The adoption decision is dependent on many factors, including but not limited to the compatibility of the family to the individual animal. I understand it is the Don’t BULLY Me Rescue’s prerogative to decide which home is most appropriate and that their decision is final.

If it is decided that at anytime your cannot keep the animal you adopted, he or she needs to be returned back to Don’t BULLY Me Rescue.

While Don’t BULLY Me Rescue makes every effort to ensure that all animals available for adoption are healthy, it is possible that any animal may have an underlying health issue unknown to Don’t BULLY Me Rescue or our veterinarian. All adults have been examined by a veterinarian, received all necessary vaccinations, been combo tested for heart worms and spayed or neutered. All puppies have been examined by a veterinarian and have received all age appropriate vaccinations. I hereby agree to hold harmless and to indemnify Don’t BULLY Me Rescue volunteers, agents and/or veterinarian, for any health issues that may arise after adoption.
I, the undersigned, hereby specifically and forever release, discharge and hold harmless the Don’t Bully Me Rescue, its agents, and any other person, firm or corporation charged or chargeable with liability, their heirs, administrators, executors, successors and assigns, from any and all claims, damages, costs, expenses, loss of service, actions and causes of action in relation to adoption of this animal.

I hereby authorize the Don’t BULLY Me Rescue to receive information from Veterinarians and others listed on this application.
Signature *
Invalid Input
Don't BULLY Me Rescue USE ONLY

Date Application Received:

Received By:

Group Name of Canine:

References Done By:

Approved By:

Denied By:

Date Adopted:

Receipt # and Amount:

Medical Records Given:

Medical Records need to be mailed:

Microchip:

Adoption Agreement Signed: