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RockySpot Rescue

Adoption Application

Please complete the ENTIRE questionaire so that we may assist you better.





Today's Date: , 20

Contact Information

Yourself
First Name:
Last Name:
Street Address:
City:
State:
ZIP:
Occupation:
1st E-Mail Address:
2nd E-Mail Address:
Home Phone:
Work Phone:
Cell Phone:
Other Phone:
Best Day/Time to Contact:
Emergency Contact
Name:
Phone Number:
Personal Reference 1
Name:
Phone Number:
Personal Reference 2
Name:
Phone Number:
Personal Reference 3
Name:
Phone Number:
Personal Reference 4
Name:
Phone Number:
Your Veterinarian
(By submitting this form, you provide your consent for your veterinarian to release information regarding the health status of your current animals).
Name:
Address:
Phone:
2nd Vet Name:
Address:
Phone:
Your Landlord
Do you own your home? : Yes   No
If you do not own your home, please provide a letter of permission from your landlord for you to have a Dalmatian and provide your landlord's:
Name:
Address:
Phone:

General Questions:

How did you hear about us? :
Why do you want to adopt a Dalmatian? :
Have you had a Dalmatian before? : Yes   No
What do you know about Dals and where did you get this knowledge?:
Do you consider yourself/your family to be active in such a way as to include your Dalmatian? Describe:

Your Home, Family, & Pets

What dogs do you currently have (Breed, Age, Sex)? :
What other pets do you currently have (Breed, Age, Sex)? :
What pets have you had in the last 5 years that you no longer have? What happened to them? :
How do your dogs get along with other dogs? :
What dog food do you feed? :
Is/are your dogs altered? : Yes   No
Ever breed a litter? : Yes   No
Willing to train in obedience? : Yes   No
Anyone home during the day? : Yes   No
Hours a day the dog would be left alone :
Where will dog stay when you are home? : Inside   Outside
When the dog is alone, where will it be (Check all that will apply regularly) ? : Run of the House   Crated
Outside   Garage
Other (Please Describe)
Is yard completely fenced and fence secure? : Yes   No
What type of fencing and height? :
Is there a door leading directly from the house into the fenced yard? : Yes   No
What kind of shade is available in the fenced yard? :
What kind of accomodations do you have for the dog in the cold? :
Do you have a dog door into the house or garage? : Yes   No
Do you own/have you used a dog crate? : Yes   No
What do you do with your pets when you go on vacation? :
Ages of children in contact with the dog? :
Any asthma or allergies to dogs or cats in your household? : Yes   No
Are your animals current on vaccinations? : Yes   No
Are your animals on heartworm preventative? : Yes   No
Describe neighbors the dog will be involved with (Do they like dogs? Have children (Ages?) Have dogs or cats?) :
Any current neighbor problems? : Yes   No
If yes, Explain :
Any preferences regarding the Dalmatian you are looking for (Age/Sex/Color)? Specify :
Do all parties (If more than one adult in house) want a Dalmatian? : Yes   No
Any questions about the breed we can answer?
Adopted pets need an adjustment time. Are you willing to give the new dog at least one month trial to ensure proper adjustment? : Yes   No
What would, in your opinon, constitute a reason for not keeping the dog? :
Would you consider a second Dalmatian at a future date? :
We are always in need of temporary homes for our rescue dogs. Would you be willing to foster a needy Dalmatian if it is compatible with your lifestyle and other pets? : Yes   No
For how long? Until placed? :

If a Dalmatian is placed with me/us, I/we agree to cooperate with ROCKY SPOT RESCUE (RSR) in its attempt to provide a smooth adoption. I also agree to contact RSR about problems that might arise in the future. Should the dog need to be placed or euthanized (prior to normal old age), I will contact RSR first to determine whether the dog might be a candidate for placement elsewhere.

If the Dalmatian placed with me is not neutered, I agree to give RSR a deposit of $100 and to neuter the dog within agreed on time frame. I realize I can not sign formal adoption papers until this is done. Once proof of neuter is received, the deposit will be refunded. If dog is not neutered within time frame, I agree to relinquish the dog to RSR.