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Vom Blue Adoption Application
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Name:
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Age:
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Email Address:
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Spouse Name:
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Age:
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Address:
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City:
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State:
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Zip:
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Phone:
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Cell:
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Employer:
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Employer Phone:
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Spouse Employer:
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Spouse Employer Phone:
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Reference Information:
If you do not have a veterinarian, you will be asked to provide the name and phone number to one prior to being approved for adoption.
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Vet Name:
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Vet Phone:
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Date of Last Visit:
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When providing personal references, please include at least two which are not related to you.
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1. Reference Name:
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1. Reference Number:
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1. Reference E-mail:
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2. Reference Name:
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2. Reference Number:
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2. Reference E-mail:
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3. Reference Name:
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3. Reference Number:
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3. Reference E-mail:
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Enviroment:
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Number of Children:
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Ages of Children:
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Please list the names and ages of anyone else living in your home that are not listed above:
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Is everyone in your home in agreement to adopt a dog?
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How long have you lived at this address?
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Describe your current living situation:
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Do you:
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If Renting please provide:
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Landlord's Name
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Landlord's Phone:
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What type of environment:
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Is there a yard:
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Fence:
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What type and how tall:
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Gate that can be locked:
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How many hours will the dog be left "alone" per day ?
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Where will the dog be kept while you are not at home ?
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Adoption Information:
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Why do you want a dog ?
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Where will the dog spend most of it's time ?
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Have you ever owned a dog?
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Sex preference:
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Age Preference:
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If interested in a specific dog please enter their name here:
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Previous and Current Pet Information :
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Please list all current pets ( Name, Age, Breed, Sex )
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Are your Pets :
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Spayed/Neutered ?
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Current on all required vaccinations:
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Taking Heartworm Prevention:
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If Yes what Type:
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Please list the pets you've owned in the past 3 years who are not listed above and what happened to them and why ? ( Ex. Fluffy , Poodle Female , Passed away at age 10 , old age )
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Do you understand that all dogs adopted from Vom Blue are to be returned to Vom Blue if the adoption does not work out? All adoption fees are non-refundable and will be considered a donation to the rescue.
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Unless otherwise noted, all Vom Blue dogs are placed as indoor family pets. Do you agree to keep this pet as an indoor family member with outdoor potty time and play time ?
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Certification: Please read the following very carefully . By signing this adoption you hereby certify that all the above information is true and correct and agree to the following terms to be considered for adoption of a rescue dog:I understand that the previous history and/or heritage of any particular dog is unknown prior to them being accepted into foster care by Vom Blue Rescue .
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I understand that providing any false or misguiding information on this application will result in immediate denial of my application . I understand that all animals placed by Vom Blue will be altered prior to adoption, and will not ask Vom Blue to deviate from this mandatory policy .
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I understand that if i am approved for adoption ,that although i may state a preference that the final decision as to what dog i will be allowed to adopt is that of Vom Blue Rescue and i agree to adhere to their advice.I understand that Vom Blue Rescue in under NO obligation to approve my application and reserves the right to deny any application without any cause or reason .
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I am 18 years of age or older , emotionally and financially capable of caring for, training, and providing a stable enviroment for a rescued dog. I will supply all medical care and every other needs to meet the well-being of this pet. And i will provide proof of Vet care to Vom Blue if required at any time. If adopted dog is not being vetted and/or treated properly , Vom Blue reserves the right to take back the adopted dog
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Full Name:
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Date:
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Vom Blue Rottweiler Rescue
Newburgh , Indiana
47630
E-mail: rottluvr303@yahoo.com
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