Hello Bully Adoption Application Your Name (required) Your Email (required) Address City State Zip Years at address Home Phone Cell Phone Work Phone Best way/time to contact you Do You?RentOwn If you rent, we need written and verbal confirmation that your landlord will allow you to have a Pit Bull. Landlord's Name Landlord's Phone How many adults live at this residence? Who will be the primary caretaker of the dog? How many people under the age of 18? (Please include ages.) If you have children, do they have experience with dogs? YesNo What level of supervision will the children have when with the dog? Has everyone in your household been included in the decision to adopt a Pit Bull? YesNo Occupation: Employer: Date of Birth: Does anyone in your household have allergies or asthma? YesNo Does anyone in your household have any physical limitations that would prevent them from caring for an active dog? YesNo Have you ever owned a Pit Bull before? YesNo Why do you want to adopt a Pit Bull? Does the county or city where you live have any Breed Specific Legislation? YesNoNot Sure Please tell us about any pets you currently own. Please include names, breeds and ages. Please tell us about other pets you have owned. For each pet, please include the following information: breed, age, length of ownership, how ownership ended. If the animal passed away, please include the cause of passing. If the animal was rehomed, please provide details. Please tell us what the dog's purpose in your life will be (Check all that apply): Companion for other petCompanion for familyGuard dog for businessCompanion for myselfCompanion for childGuard dog for home/personal protection Where will the dog spend most of his or her time? Tied out in yardBasement or garageIndoors with familyOutdoor KennelIn fenced yardIndoor/Outdoor Kennel What outdoor areas will your dog have access to? (Check all that apply.) Enclosed dog runUnfenced YardTie out (cable)Fenced YardTie out (chain) How many hours a day will the dog be left at home alone? Where will the dog spend his or her time when home alone? Tied out in yardBasement or garageCrate or indoor kennelFree in houseIn fenced yardOutdoor Kennel Where will the dog sleep at night? If you have other pets, how will they be managed when unsupervised? How do you plan on exercising the dog? What types of training methods do you plan on using with your newly adopted Pit Bull? Do you plan on taking your adopted Pit Bull to an obedience or training class? YesNo If yes, is there a specific trainer or facility you plan on using? Please tell us what your expectations are of the dog's behavior? Comes when CalledHousetrainedKnows Basic CommandsWalks well on leash If behavior problems arise, are you willing to work with a trainer or behaviorist? YesNo (Hello Bully offers free consultations and free or low-cost training assistance.) Under what circumstances would you decide not to keep your new dog? New RoomatePregnancy or New BabyDog having behavior problemsSeparation or DivorceNew Carpet or FurnitureIllness or AllergiesChange in employmentMovingVeterinary Expenses Please provide three references (not related to you) who we can contact to attest to your character. Please include one Veterinarian if possible. Is there anything else that you'd like us to know about you as a potential adopter? By checking yes, I understand that Hello Bully and/or the current caretaker reserve the right to refuse adoption at their discretion. YesNo By checking yes, I agree that the dog will be kept as a companion house pet. The dog will not be used in any medical experimentation or illegal activities. YesNo By checking yes, I understand that some insurance companies may deny or discontinue coverage based on the breed of dog I own. I agree to check with my insurance company prior to adopting a Pit Bull. YesNo By checking yes, I understand that Hello Bully and/or the current caretaker will contact the references I have provided. They may also conduct a home or property check and a criminal background check at their discretion. YesNo By checking yes, I agree that I have never been convicted of a crime involving the neglect, abuse or other illegal activity relating to an animal. YesNo By checking yes, I absolve Hello Bully and the current caretaker from any and all liability relating to or resulting from the ownership of a dog adopted from them. Upon adoption, I agree to assume full responsibility for the dog's actions, including any and all damages done by the dog. YesNo By signing below, I agree that the information I have provided in this application is true and I agree to abide by all the conditions listed above. Full Name Today's Date Thank you for your interest in giving a loving home to a rescued Pit Bull.