Delaware Valley Bichon Rescue

Adoption Application



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	Delaware Valley Bichon Rescue 711 Chapel Road Cinnaminson, NJ 08077 phone: 856-829-7615 fax: 775-637-4324 susandare@comcast.net

Please fill out this entire application to the best of your knowledge. Before submitting your adoption application, please review our adoption agreement contract.

This application MUST be completed and submitted by an ADULT member of the household. In completing this application, you acknowledge that our adoption fees range from $125 to $275, with MOST dogs being $225. In addition, understand that adopters are responsible for making transportation arrangements once an adoption has been finalized.

Your application will be reviewed by one of our volunteers as quickly as possible. You will receive an e-mail confirming that we have received your application within ten days, usually much sooner.

Due to the large volume of applications we receive, it is impossible for us to remain in contact with every applicant. After you receive an email confirming our receipt of your application, you will ONLY be contacted if and when we believe we have a dog that might be a good match for your specific household. However, you are encouraged to visit our website often & contact us when YOU see a dog that interests you. It is NOT necessary to file multiple applications. Your initial application will be held indefinitely.

Contact & Personal Information

First name:		Last Name:
Address:		City:
State:		Zip:
Home Phone:		Work Phone:
Email:		Confirm Email:
Age:
Occupation:		Employer:

Co-Applicant

First name:		Last Name:
Age:
Occupation:		Employer:

Place of Residence Information

Type of home:		If Other, please explain:
Do you own or rent your home?		Indicate the type of Neighborhood you live in:
Will you be relocating in the near future?
Do you have a completely fenced yard?		If you do not have a fenced yard, how do you plan to address the dog's bathroom & exercise needs?
Do you have a swimming pool?		If you have a pool, is it fenced separately?
Is your home air conditioned during the summer months?		Is your home a smoking household?
Have you ever owned a dog who spent most or all of his or her time outside for any reason?		If so, please explain the reasons for this & describe where that dog is at this time.

Occupants & Ownership Information

How many adults are in your household?		Is everyone in the household aware of and agreeable to your interest in adopting?
Which member/s of the household mostly want a dog?	For example: Husband, Wife, Husband & Wife, Kids, or All
How many children reside in your home?		Please indicate the ages of all children that reside in your home:
Who will be the primary caregiver for this dog(s)?		Age of primary caregiver (if under 18):
Are there regular visitors to your home (human or animal) with which your new dog must get along?		Please describe:

Pet Ownership Experience & Information

Is this your first dog?		Is this your first Bichon?
Have you ever had to euthanize a dog or cat?		If yes, please explain:

Past Dog Ownership
Please list all dogs, including age(s), sex, breed(s) you have owned in the past and what happened to each of those dogs:
Have you ever given a dog to a shelter or rescue?		If yes, please explain:

Current Dog Ownership
How many dogs do you currently own?
For each dog you currently own, please indicate their name, breed, sex, age, altered & vet care:
Dog 1:	Name: Breed: Sex: Age: Altered: Up-to-date on veterinary care/shots?
Dog 2:	Name: Breed: Sex: Age: Altered: Up-to-date on veterinary care/shots?
Dog 3:	Name: Breed: Sex: Age: Altered: Up-to-date on veterinary care/shots?
Dog 4:	Name: Breed: Sex: Age: Altered: Up-to-date on veterinary care/shots?
If you currently own more than 4 dogs, please indicate their name, breed, sex, age, vet care & altered for the additional dogs here:

Current Cat Ownership
How many cats do you currently own?
For each cat you currently own, please indicate their name, sex, age, altered, how kept & vet care:
Cat 1:	Name: Sex: Age: Altered: Indoor/Outdoor/Both: Up-to-date on veterinary care/shots?
Cat 2:	Name: Sex: Age: Altered: Indoor/Outdoor/Both: Up-to-date on veterinary care/shots?
Cat 3:	Name: Sex: Age: Altered: Indoor/Outdoor/Both: Up-to-date on veterinary care/shots?
Cat 4:	Name: Sex: Age: Altered: Indoor/Outdoor/Both: Up-to-date on veterinary care/shots?
If you currently own more than 4 cats, please indicate their name, sex, age, altered, how kept & vet care for the additional dogs here:

Veterinarian Information
Vet's Name:
Address:
Phone:

Adoption Preference Information

If you are applying for a specific dog or dogs, please list name(s) here:
Would you consider a dog that is NOT housebroken?		If yes, briefly explain how you would housetrain a dog:
Age Preference: (check all that apply)	Under 6 mos. 6-12 mos. 1-2 yrs. 3-4 yrs. 5-6 yrs. 7-8 yrs. 9-10 yrs. 11-12 yrs. 13-14 yrs. Over 14 yrs.
Sex Preference:
Weight Preference:		Would you consider a special needs dog?

The New Dog

How many hours per day will you dog be alone (without an ADULT present) during the week?		How many hours per day will you dog be alone (without an ADULT present) on weekends?
Where will the dog stay when you are out? (check all that apply)	Loose indoors Loose outdoors Crate Basement Garage Tied up outside Kennel run Doggie daycare Other
	If Other, please describe:
Where will the dog sleep at night? (check all that apply)	Loose indoors Loose outdoors Crate Basement Garage Tied up outside Kennel run In bedroom Other
	If Other, please describe:
Do you plan to use a crate?		What's the maximum length of time you plan to use the crate on an average day?
If you plan to use a crate, under what circumstances will the crate be used?

Additional Information

Do you understand that most dogs adopted from DVBR require a $225 adoption fee?		Do you understand that in most cases, you are expected to pick up the dog you are adopting from the rescue?

Do you agree to let a DVBR representative visit your home by appointment?		If no, explain why not:

Please let us know any other information you wish us to consider in placing a dog with you. Here is your chance to personalize this application.)


By pressing the SUBMIT button, you attest that all of the information you have provided in this application is true and correct. Please do not hit the SUBMIT button more than once. You will receive a confirmation page when your application has been processed. If you have any problems submitting this form please email us and make sure you describe what happened. You can also print out your application and mail it to: Delaware Valley Bichon Rescue, 711 Chapel Road, Cinnaminson, NJ 08077. Thank you for taking the first step towards being a part of the solution and showing a willingness to adopt a homeless dog.

		Delaware Valley Bichon Rescue is a non-profit organization as recognized by the Internal Revenue Service pursuant to Section 501(c)3, et seq. of the Internal Revenue Code. All donations are 100% tax-deductible.

Many thanks to Patty Burke for allowing us to use her Bichon image in our logo. This image is copyrighted
and may NOT be copied from this website without the written permission of Patty Burke.