Adoption Application

How did you hear about Midwest Rescue?

Please provide the name of the dog you are interested to adopt

Do you prefer male or female? Select Male Female

Do you prefer adult or puppy? Select Adult Puppy

If you’re looking for a guard dog, what is it intended for? Select Business Residence Neither

Is your home a house or an apartment? Select House Apartment Other

If you have chosen other to the question above please explain.

Do you own the property? Select Yes No Other

If other, please specify:

If you rent, do you have your landlord’s permission to keep a pit bull? Select Yes No

Please provide your landlord’s name and phone number for verification:

Home location:

In the past five years, how many times have you moved?

Does your municipality have breed specific restrictions? Select Yes No

If so, please describe them:

Where will your dog live? Select Indoors with family Basement Garage Outdoors In doghouse Other

If your answer was “other,” please explain:

Where will your dog be when you are not home? Select Indoors loose Indoors crated Outdoors on a run Outdoors in fenced yard Outdoors in kennel Other

If you have chosen other, please explain:

How many hours a day will your dog be home alone?

How will you exercise your dog? (check all that apply)

Daily walks on leash
Dog run in yard
Free run in fenced yard
Free run in unfenced yard, supervised
Free run outdoors
Visits to dog park

What is your yard size?

Is the yard enclosed by a fence?

Type & size of fence

How many adults (21 and older) are in your household?

How many children under 21 are in your household?

What are the ages of all children under 21?

Does everyone in the home share your desire to adopt a pit bull? Select Yes No

Who will be responsible for the dog’s daily care and expenses?

Do you have other dogs? Select Yes No

If answering yes, please specify how many you have:

What are their genders?

How many are spayed or neutered:

Please specify breeds and ages of other dogs:

If you had other dogs in the past, please let us know the current status of those dogs.

If you have or had other dogs, are/were they on heartworm medication? Select Yes No

Would you like us to explain what heart worm disease is and how to prevent it? Select Yes No

What other kind of animals do you own?

Have you ever given up a pet? Select Yes No

Have you ever owned a pit bull before? Select Yes No

If yes, please explain:

Of all the breeds available, why do you want a pit bull?

Please relate any prior experience you have had with this breed:

Have you ever had a pet impounded by animal control? Select Yes No

If your pet was impounded, did you eventually reclaim it? Select Yes No

Have you ever been convicted of any crime relating to animals, such as animal cruelty or dog fighting? Select Yes No

If your answer is yes, please explain:

When you go on vacation, what will you do with your dog? Select Bring along Board at facility Board at vet clinic Get a pet sitter Board with friend or family Other

If you answered “other,” please explain:

Do you have a veterinarian? Select Yes No

Would you like us to recommend one in your area? Select Yes No

Would you return your dog to Midwest Rescue for any of the following reasons (check all that apply):

A move
A move to a place that does not permit pit bulls
Change in living partner (i.e., marriage, divorce)
Change in job (i.e., job transfer, loss of job, hours change)
Allergies
Having a baby
Dog isn’t housebroken
Dog is badly behaved
Dog does not get along with current pets
Dog develops medical problems
Dog becomes too expensive

Please supply the name and phone number of your current veterinarian, employer, clergyman, or anyone not related to you who can attest to your character:

Owning a dog means paying for its food, toys, veterinary care, immunizations, and more. Are you ready to pay these expenses for the dog’s entire life? Select Yes No

Any additional information you would like to provide: