Date:

Your Name: Spouse's Name:

Street Address:

City: State: Zip Code:

Home Phone #: Work Phone #:

Cell Phone #: E-mail:

Your Occupation:

Spouse's Occupation:

Ages of Adults in your household (separate with commas):

Ages of Children in your household (separate with commas):

Do you have relatives or friends with small children who visit often? Select one Yes No

Is there anyone in your home with animal related allergies? Select one Yes No

If "Yes", please explain:

How far could you drive to pick up a dog?

The four following questions must be answered or your application won't be considered. Note that the caretakers of any dog listed with "A Better Place" may have their own contract and/or require additional release waivers.

1. By checking YES you agree to absolve "A Better Place" and all of its
representatives from any liability in reference to a dog featured on the
abetterplace.petfinder.com website.

Yes No

2. By checking YES you agree that the dog will not be used in any
illegal activities.

Yes No

3. By checking YES you agree that the dog is to be kept as a house pet. It shall not be sold for medical or experimental purpose, and it shall not be used for breeding.

Yes No

4. If you are applying to adopt a pit bull or pit bull mix. By checking YES you agree that the dog will not be found at any time in a municipality where pit bull presence is illegal.

Yes No Does Not Apply

Name of dog - Choice #1 (required):

Name of dog - Choice #2 (optional):

Name of dog - Choice #3 (optional):

Are you looking for a:
Male Female Either

Do you prefer a:
Puppy Adult Senior Doesn't Matter

If you have a preference in color and weight, please describe it here:

Prefer dog to be: (check all that apply)

Already spayed or neutered

Not spayed or neutered

Doesn't matter

Additional requirements about the dog you would like to add:

Dog's living situation: (check all that apply)

Dog will be house pet, living inside with family

Dog will live in basement or garage

Dog will live outdoors

Doghouse provided

Guard Dog for business

Guard Dog for residence

Other - please specify:

How many hours a day will dog be home alone?

When home alone dog will be: (check all that apply)

In a crate, wire cage, or dog pen inside

In an outdoor kennel

Tied up outside: Cable run with a chain

Dog will be loose outdoors

Dog will be loose indoors

Dog will be loose both indoor and outdoor

Other - please specify:

How will you exercise the dog: (check all that apply)

Leash walks everyday

Will have cable or dog run in the yard

Will be free to run in fenced yard

Will have supervised access to unfenced yard

Will be free to roam around (Off leash and unsupervised in unfenced area)

Will bring to dog park (Public area where dogs can run and play
together off-leash)

Other - please specify:

What type of setting is your home located in?
Urban Suburban Rural

Yard size is:
Small Medium Large Acreage No Yard

Is the yard enclosed by a fence? Yes No

If "yes", please describe the height, length, and type of fence:

Do you live in a: House Apartment

Do you own the property? Yes No

If you are renting, please provide Landlord's name and phone number for verification:

Are you planning on moving within the next year? Yes No

Do you have other dogs? (check all that apply)

No other dogs

One or more spayed female

One or more neutered male

One or more UNspayed female

One or more UNeutered male

Please specify breeds and ages of other dogs:

Are your current dogs on heartworm preventative? Yes No

What other kinds of animals do you own? (please specify)

If you own cats, are they indoor or outdoor cats? Indoor Outdoor

If you had other dogs in the past, please let us know their current disposition:

Still have the dog(s)

Died of old age

Died of fatal disease

Gave or sold to friends, relatives or acquaintance

Returned to a rescue group, Humane Society or shelter

Was hit by a car

Was stolen

Disappeared/Lost

Please specify what happened to your previous dog(s):

Please tell us the breeds, names, ages of your past pets:

If you have had other pets in the past, were they spayed/neutered?
Yes No

Who will care for your pet during vacations?

Have you done obedience work with a dog?
Yes No

What is your definition of disciplining a dog? Please provide examples:

List any bad behaviors that may have bothered you about a past pet:

What will you do if your dog is destructive while left alone?

List the types of behavior problems you consider NOT acceptable:

Which reasons are acceptable reasons for giving up your dog?

Fence Jumping
Moving
Illness
Biting
Puppy/Kitten Destructiveness
Chewing
Stealing Food
Allergy
Growling
Housebreaking Accidents
Showing Teeth
Too Active
Scratching
Compatibility with other Pet(s)
Hides for First Week

Other reasons (please specify):

It may take your new pet a month (or longer if other pets are involved) to adjust to its new home. What will you do if your pet displays undesired behavior (see above for examples) during this adjustment time?

Have you ever had to give up a pet?
Yes No

If "Yes" please tell us when and why you gave up your pet:

Vet References: Please supply the name and phone number of your current veterinarian, or the one who saw your previous pet(s). Please include city, state of the veterinarian:

Personal References: Please provide the names and phone numbers of two people not related to you, who can attest to your character. Please include your relationship to each person:

Additional information you would like to provide about yourself and/or the dog you would like to adopt:

Of all the breeds available why do you want a Pit Bull? ("Pit Bull" is a general term used to describe three different breeds with similar characteristics: American Pit Bull Terrier, American Staffordshire Terrier, or Staffordshire Bull Terrier):

Does your municipality (i.e., city, township or state) have breed specific restrictions?
Yes No Don't Know

If "Yes" please describe the nature of the restrictions:

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

Will your family be supportive of you owning a Pit Bull?
Yes No Don't Know

Do they have any reservations about the breeds?

Did you know that Pit Bull dogs are banned in some cities and states?
Yes No

Did you know that some apartment complexes, townhouses, and condo associations do not allow pit bulls?
Yes No

Please review ALL the information provided before you click "Submit Form". Only click "Clear Form" if you wish to start over.