Robbi's Adoption Application

Robbi's Adoption Application

The goal is to provide loving homes for the dogs and to ensure their well being and lasting happiness
Robbi Lee Roy is dedicated to the rescue and placement of owner surrenders, shelter dogs, stray, neglected and abused dogs. All of the dogs are well cared for and receive complete medical care, which includes de-worming, vaccinations, spaying/neutering and 4DX testing prior to their adoption.

This questionnaire is designed to help Robbi Lee Roy and yourself determine if a specific dog is the right one for you and your household. All adopting parties are required to complete this form prior to adoption. Robbi Lee Roy reserves the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoptions.

All applicants are required to have a vet reference check. If approved, then the applicant will have a meet n greet with the dog.
PLEASE COMPLETE ALL INFORMATION
Name of the dog you are interested in: *
Are you over 18 years of age? *

Yes No
Date of Birth *

Month Day Year
Date
Date of Birth *
mm-dd-yyyy
*** Personal Information ***

** All applicants must be 18 yrs old or older to adopt a dog **
Your Full Name *

First Name Last Name
Co-Applicant or Significant Other's full name:

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Your age: *
Home Phone:

Area Code Phone Number
Work Phone:

Area Code Phone Number
Cell Phone:

Area Code Phone Number
Best time to call: *
E-mail: *
Occupation: *
Co-Applicant or Significant Other's Occupation:
How many adults are in your household? *
Do you have any children? *

Yes No
If yes, name(s) and age(s) of children.
How many children are in your household? *
*** Household Information ***
Do you live in a ... *

House Apartment Condo Mobile Home
Do you own or rent? *

Own Rent
If you rent, do you have permission to keep a dog? *

Yes No Do Not Rent
If you rent, provide landlord's name.
Landlord's phone number

Area Code Phone Number
Are there any restrictions from your landlord or subdivision? Check all that apply. *

Number of pets Size or weight restrictions Breed restrictions None Not Applicable
Years at current address: *
If less than 1 year - previous address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Are all members of your household in agreement with this adoption? *

Yes No Don't Know
Do you have a fenced yard? *

Yes No Partially Fenced
Do you have any of the following? Check all that apply *

Underground fence Outdoor Kennel Dog Run 4' Chain link/Wooden/Vinyl fence 5' Chain link/Wooden/Vinyl fence 6' Chain link/Wooden/Vinyl fence 7' Chain link/Wooden/Vinyl fence 8' Chain link/Wooden/Vinyl fence Partial Fenced in Yard
How will you handle toilet duties? *
How many hours per day will the dog be left alone? *
Where will the dog be kept when you are out of the house? Check all that apply. *

In House Roam Free Gated Room Crate Basement Outdoor Kennel Dog Run Tethered Outside
Daytime ... Check all that apply. *

In House Roam Free Gated Room Crate Basement Outdoor Kennel Dog Run Fenced in Yard Tethered Outside
Night-time ... Check all that apply. *

In House Roam Free Gated Room Crate Bedroom Outdoor Kennel Dog Run Basement Fenced in Yard Tethered Outside
Have you owned a dog before? *

Yes No
If you have children or grandchildren, have they been around dogs? *

Yes No
Do you have grandchildren that visit often *

Yes No
List ages of grandchildren
Does anyone in your home have allergies to dogs or have asthma? *

Yes No
Explain what kind of allergies
*** Dog Information ***
Do you own a dog(s) now? *

Yes No
How many?
List all names, sex, breeds and ages of dogs you own now
Is your dog(s) spayed/neutered? *

Yes No
If not spayed or neutered, reason why?
Deceased Dog(s) ... List all names, sex, ages, breeds and cause of death
Have you adopted from a shelter or a rescue group before? *

Yes No
Have you ever given up a dog? *

Yes No
If yes, what were the circumstances?
*** Cat Information ***
Do you own a cat now? *

Yes No
How many?
List all names, sex, and ages of cat(s) you own now
Is your cat(s) spayed/neutered? *

Yes No
If not spayed or neutered, reason why?
Deceased Cat(s) ... List all names, sex, ages, and cause of death
Have you adopted a cat from a shelter or a rescue group before? *

Yes No
Have you ever given up a cat? *

Yes No
If yes, what were the circumstances?
*** Veterinary Information ***
It is required that all applicants must have a vet reference check.

Please call your vet and release your records to Robbi Lee Roy.

Thank You
May we contact your current vet? *

Yes No
Name of your Veterinary Facility *
Address of your Veterinary Facility *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Veterinary Facility Phone Number *

Area Code Phone Number
Can you provide documentation if asked, that your pet(s), previous or current, are up to date on all necessary shots and are spayed or neutered? *

Yes No
Will you allow a representative to visit your home by appointment? *

Yes No
*** New Dog Information ***
What age group are you looking to adopt? Check all that apply. *

Puppy (8 weeks to 1 yr old) Young (1 yr old to 2 yrs old) Adult (2 yrs old to 7 yrs old) Senior (over 7 yrs old) Any Age Group
Are you looking to adopt a *

Special Needs Dog Hypoallergenic Dog Short Haired Dog Long Haired Dog Low Shedding
What size dog are you looking to adopt? Check all that apply. *

Small (25 lbs or less) Medium (26 - 60 lbs) Large (61 - 100 lbs) X-Large (101 or more lbs)
Do you understand that the breed of most rescue dogs that we rescue are not fully known? *

Yes No
Do you understand that when we rescue a pregnant mother, the father is not known, and the puppies can be multiple breeds? *

Yes No
Many of the rescue dogs that we rescue are not fully house trained, are you wiling to train and work with them? *

Yes No
If you are adopting a senior dog, do you understand that they may have accidents in the home. *

Yes No
Have you ever house-trained a dog or puppy before? *

Yes No
If the dog has an "accident" in your home, what type of correction do you plan to use? *
Are you aware of crate training? *

Yes No
Will you be using a crate? *

Yes No Maybe
Are you willing to work with the new dog on basic training? *

Yes No
Do you plan to take an obedience class with your dog? *

Yes No Not sure
Are you aware that a new environment is stressful for your dog, and they may exhibit uncharacteristic behavior's, such as, accidents in the house, being shy, barking, not eating for a few days, having diarrhea, etc. *

Yes No
A new dog in a new home takes time to adjust to his new surroundings. Are you willing to work with him/her to adjust? *

Yes No
What length of time will you allow your new dog to adjust to his new home? *

1 week 2 weeks 3 weeks 1 month
Do you understand that a dog can be an 18 year commitment, and can cost $300 - $500 or more per year to care for? *

Yes No
How did you find out about Robbi Lee Roy's dog(s)? Click all that apply. *

Adoptapet.com Petfinder.com Facebook Friend/Family Member Website
Is there any other information that might help us place a dog with you?
*** Disclosure ***
Robbi Lee Roy's Dogs are house dogs and are not to be housed outdoors or allowed to roam free. All puppies not spayed/neutered must be done by 6 months of age or appropriate date given by the new vet and the new owners. Proof of spay/neuter must be provided within 10 days of the procedure. This will be outlined in the adoption ontract should you be allowed to adopt a Robbi Lee Roy dog.

All of the information I have given is true and correct. I will provide this dog with proper and sufficient food, water, shelter and medial care, companionship and humane treatment at all times. I agree that Robbi Lee Roy is in no way liable or responsible for any damage, accident or injury resulting in the placement of a dog into my househole.

We reserve the right to refuse any person or persons from fostering or adopting a dog through Robbi Lee Roy. Completing an application for adoption does not guarantee or promise a dog. The best possible match will be found for each dog based upon their current needs.
Applicant Signature *

Clear
Applicant Name *

First Name Last Name
Today's Date *

Month Day Year
Date
Applicant Driver's License #:
State: *
Please attach a copy of either your driver's license or photo ID with your name and address on it for identification purposes. *

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Co-Applicant or Significant Other
Co-Applicant or Significant Other's Signature

Clear
Co-Applicant or Significant Other's Name

First Name Last Name
Today's Date

Month Day Year
Date
Co-Applicant or Significant Other Driver's License #:
State:
Please attach a copy of either your driver's license or photo ID with your name and address on it for identification purposes.

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Cancel of
Thank You for your interest in adopting a rescue dog
Should be Empty:

Robbi's Adoption Application

PLEASE COMPLETE ALL INFORMATION

*** Personal Information ***

*** Household Information ***

*** Dog Information ***

*** Cat Information ***

*** Veterinary Information ***

*** New Dog Information ***

*** Disclosure ***

* Personal Information *

* Household Information *

* Dog Information *

* Cat Information *

* Veterinary Information *

* New Dog Information *

* Disclosure *