Date of Birth*
How did you hear about us?
Employer, employer address, length of time with this employer:*
Please list the address, phone number, and place of employment for your spouse*
Which dog are you interested in adopting?
Choose an animal:
What qualities about this particular dog appeal to you?
What energy level are you looking for?
What general age group are you looking for?
Who will be providing care for the animal?*
What type of exercise will you be able to provide for your new dog?*
Please use this space to describe your lifestyle: (active, outdoorsy, sedentary, travel often, military, etc).*
Why is now a good time to adopt a dog?*
Do any of your family members, relatives, friends, or neighbors, have negative views on Pit Bulls?*
What type of home do you live in?
Length of time at this address:*
Do you own your home?
Please provide your landlord's name and contact information if you are currently renting:*
Please list the name, age, and relationship of all persons in the household:
Have you ever fostered or owned a Pit Bull before?
Please describe your experience, if any, with this breed:
Have you ever managed a multi-dog household?
If you currently have companion animals, please list the name, breed, age, sex, and if the animal is spayed/neutered. If not spayed/neutered, please explain:*
If you have previously had companion animals, please list the name, breed, years owned, and what happened to the animal:
What training methods will you use? If your new dog misbehaves, how will you correct him?
Please list any unacceptable/"deal breaker" behaviors in your new dog:*
Will your new dog be left outdoors unattended/tethered/tied for any period of time? If so, when?
Have you or your spouse ever taken an animal to an animal shelter? If yes, describe the circumstances.*
Have you or anyone living in your household ever been accused or charged with animal abuse, neglect, or abandonment? If yes, please explain.*
Please provide the name of your veterinarian, phone number, and hospital address*
Will you allow a VPBR representative to perform a home visit prior to adoption?
Please use this spaced to list any questions, concerns, or expectations you have about adopting a Pit Bull.
By entering your name and the date, you certify that the above information is true.*