Burttschell Rescue Ranch Adoption Application

Please put NA in any field that doesn't apply to you, all fields are required and must be filled out in order for the application to submit.

Address Address
Street Address City Postal / Zip Code
Which dog(s) are you interested in adopting?
Daytime Phone:
Contact Information
Full Name
Evening Phone:
Best time to call:
Occupation:
Place of employment:
Email address:
Family & Housing
Please put your Home, City & State & How long at this address:
How many adults are there in your family (their relationship to you)?
Names of all adults living in home:
How many children (ages)?
What type of home do you live in single family, town home, apartment, farm, etc.?
Please describe your household:

Please describe your household: Active Noisy Quiet Average
If you rent, please give the rules governing pets and the landlord’s name and number:

(By providing this information you are allowing BRR to contact your landlord please inform them of this call so they will speak with us)
Does anyone in the family have a known allergy to dogs?
Is everyone in agreement with the decision to adopt a dog?
Do you have time to provide adequate love and attention?
Other Pets
What other pets do you have (specify type and number)?
Are these pets up to date on vaccines?
Are these pets spayed/neutered? If not, why?
Have you every surrendered a pet? If so, why?
Have you ever had a pet euthanized? If so, why?
Have you ever lost a pet to an accident?
How do you discipline your pets and why?
Veterinarian Information
(Providing BRR with this information you are allowing BRR to call your vet. Please call your vet and ask them to authorize the release of information to BRR.)
Do you have a regular vet?
Veterinarian’s name:
Clinic's name:
Clinic's address:
Clinic's phone:
About the Dog You Wish to Adopt
What is your idea of an ideal dog and why?
Desired age:
Desired size:
Desired breed:
Breed you would not adopt:
Desired sex:

Desired sex: spayed female neutered male no preference
Willing to adopt (choose all that apply):

Willing to adopt (choose all that apply): outgoing/hyper dog shy dog dog that needs regular medication dog that needs training dog that needs grooming senior dog none of these
Where will the dog spend the day? (describe)
Where will the dog spend the night? (describe)
Number of hours (average) dog will spend alone?
Who will have primary responsibility for this dog's daily care?
Who will have financial responsibility for this dog?
Do you agree to provide regular health care by a Licensed Veterinarian?

Do you agree to provide regular health care by a Licensed Veterinarian? yes no
Do you agree to keep the dog as an indoor dog?

Do you agree to keep the dog as an indoor dog? yes no
Do you agree to contact BRR if you can no longer keep this dog?

Do you agree to contact BRR if you can no longer keep this dog? yes no
Are you be willing to let a representative of BRR visit your home by appointment?

Are you be willing to let a representative of BRR visit your home by appointment? yes no
When the dog goes out, how do you plan to supervise it? Do you have a fenced yard (if so describe)?
How did you hear about BRR?
Would you be interested in fostering?

Would you be interested in fostering? yes no I would like to know more about fostering, my questions below:
Personal References
Please list someone who is familiar with both you and your pets.
Name, Address, Phone & Relationship to you (relative, neighbor, friend, etc.):
Name, Address, Phone & Relationship to you (relative, neighbor, friend, etc.):
All of the information I have given is true and complete. This dog will reside in my home as a pet. I will provide it with quality dog food, plenty of fresh water, indoor shelter, affection, annual physical examination and vaccinations under the supervision of a licensed Veterinarian.

Adopter MUST return this dog back to our rescue if you can no longer provide for the dog’s care. By signing this contract, I understand that that I cannot give this dog to anyone else without permission of BRR.

This contract stands as a spay/neuter contract if your puppy is not spayed or neutered. The puppy MUST be returned to BRR at the age of 6 months to be fixed or the puppy must be returned without refund.
Please sign in the box:
I understand this is a legal representation of my signature.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Partner/Spouse please sign below if applicable:
I understand this is a legal representation of my signature.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.

Burttschell Rescue Ranch Adoption Application

Burttschell Rescue Ranch Adoption Application

Contact Information

Family & Housing

Other Pets

Veterinarian Information (Providing BRR with this information you are allowing BRR to call your vet. Please call your vet and ask them to authorize the release of information to BRR.)

About the Dog You Wish to Adopt

Personal References Please list someone who is familiar with both you and your pets.

Veterinarian Information
(Providing BRR with this information you are allowing BRR to call your vet. Please call your vet and ask them to authorize the release of information to BRR.)

Personal References
Please list someone who is familiar with both you and your pets.