PART ONE
Contact and Personal Information

First Name:

Last Name:

Street Address:

City: State: Zip:

Contact Phone #: Alternate Phone #:

Email address:

Do you live in a rental home/apartment, or in a county/area which enforces breed specific restrictions? (this means that Pit Bulls are NOT allowed in the area and or/home where you live)
Yes No

If yes, please describe the nature of the restrictions:

How old are you? under 13 14-17 18-20 21-25 26 or older Your Spouse (if applicable) under 13 14-17 18-20 21-25 26 or older n/a

Employer's name/number:

How long have you been employed with this company?

Spouse/partner's full name:

Spouse/partner's employer name/number:

How long has your spouse/partner been employed with this company?

One of the requirements to adopt form our organization is that home checks must be conducted:
Are you willing to allow a representative to visit your home?
Yes No

Do you have a securely fenced yard ? Yes No

Yard size is: Small Medium Large Acreage No Yard

Do you live in a(n) apartment rental home owned home
condo town home mobile home

Is the home in an Urban Suburban Rural setting?

If you are renting, do you have the landlord's permission to own a Pit Bull?
Yes No

Please provide landlord's name and phone number:

**PROOF MUST be provided before adoption: we reserve the right to
contact landlord or apartment complex for verification.

Do you live with: Spouse/Partner Roommate(s) * Parents Alone

* If living with roommates, how many?

Who will be primarily responsible for the financial expenses and daily care of the dog?

Does every individual in your home agree to adopting a pit bull? Yes No

Do any individuals in your home have allergies to animals/dogs? Yes No

How often have you moved in the past 5 years?

How many adults OVER 21 are in your household?

How many individuals UNDER 21 are in your household?

Do any children (under 18) live in or visit the household?
Yes No

What are the ages of the children?

Is this your first time owning a Pit Bull? Yes No

Have you ever been convicted of animal cruelty, dog fighting or other
crime relating to animals? Yes No
If so, please explain:

Have you ever had an animal impounded by animal control due to an eviction?
Yes No

Have any of YOUR pets (not strays) been picked up by/taken to animal control?
Yes No

If yes, why?

Was the animal reclaimed? Yes No N/A

If not, why?

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PART THREE
Dog(s) you are interested in adopting

After you have seen available prospects for adoption, please provide the name and information of the dog(s) you are interested in adopting. (Ex: Rosco- red male Pit Bull)

Choice #1 (required):

Choice #2 (optional):

Choice #3 (optional):

Choice #4 (optional):

Are you looking for a: Male Female Either

Do you prefer a: Puppy Adult Either

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

Additional requirements/preferences about the dog you would like to adopt?

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PART FOUR
Living situation and lifestyle

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 in garage
Dog will live outdoors/doghouse provided
Dog will live both indoors/outdoors
Guard Dog for: Business Residence
Other- Please explain:

Have you ever had an "outdoor only" pet? Yes No

If yes, describe their living conditions:

How many hours a day will your dog be home alone?

When home alone, dog will be (check all that apply):
In a crate, wire cage or dog pen inside
In a Kennel: Outdoor Indoor Both
Tied up outside: Cable Run Chain
Dog will be loose: Inside Outside
Other (please explain):

How will you exercise the dog? (check all that apply):
Leash walks every day
Will have cable or dog run in the yard
Will be free to run in fenced yard*
* Will fenced yard access be supervised unsupervised
Will have supervised access to unfenced yard
Will be free to roam around (Off leash and unsupervised in unfenced area)
Will bring to park- dog will be leashed and interaction with other dogs will be limited
Will bring to dog park- public area where dogs can run and play together off-leash
Other (please explain):

Where will do dog be when you /your family go on vacations? (check all that apply)
Dog will go with you/family on vacations
Dog will be boarded at a vet clinic/boarding facility
Dog will stay with friend/family member
Other (please explain):

What reasons would cause you to consider giving your adopted Pit Bull back to Pit Prints, or cause you to no longer be willing to commit to him/her? (check all that apply)

Job change (increased work hours, longer commute time, change of schedule, loss of job/income), career change, or decision to attend/return to college
Living situation changes (move to new home, move in with spouse/partner, obtain roommate(s)
You move to an area/home which does not allow Pit Bulls
Someone in household develops allergies to animals/dogs
You decide to get marriage, separated, or divorced, or decide to have a baby
Dog escapes from yard
Dog chews on furniture, house, etc. or is destructive when not supervised
Dog has housebreaking/crate training problems
Dog has behavioral problems such as separation anxiety, etc.
Dog does not get along with your current dog(s), cat(s), or other pet(s)- please be advised that even Pit puppies CAN mature to be dog aggressive- you are NEVER guaranteed that a Pit Bull of ANY age will ALWAYS get along with other animals.
Proper vet care is too expensive for you
Dog develops health conditions in the future
Other (please explain):

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PART FIVE
Other Pets and experience

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 UN spayed female
One or more UN neutered male
If you have one or more dog that is not spayed and/or neutered, please explain why:

Please specify breeds and ages of other dogs:

If you had other dogs in the past, please let us know their current disposition:
Still have the dog(s)
Died of old age (fatal disease)
Gave or sold to friends, relatives or acquaintance
Was hit by a car
Was stolen
Disappeared/lost
Please specify what happened:

Have you ever had to give up a Pet for any reason? Yes No
If yes, please explain why:

What other animals do you own?

Of all the breeds available why do you want a Pit Bull?

Experience: Please relate any/all prior experience you have had with this breed:
if you have no experience type "none"

Please enter the name, address and phone number of your past AND/OR current veterinarian/clinic name?
(please provide information for all vets that you have used)
if you have never had a vet type "none"

** If you do not have a veterinarian, Please feel free to ask us for recommendations in your area. Within 30 days of adopting from our organization, a relationship needs to be established with a veterinarian.

References: Please supply the name and phone numbers of your employer, clergyman or anyone not related to you who can attest to your character. Please provide more than one reference:

Do you know what heart worm disease is and how to prevent it?
Yes No
**If you do not know we will be more than happy to explain.

Is/were your current dog(s)/previous dog(s) on heart worm prevention?
Yes No  

Are you aware of the financial responsibility involved in owning a pet
(high quality food, treats, toys, annual vaccinations, flea prevention,
heart worm prevention, emergency costs, etc.) and are you prepared to
take care of this animal for the duration of its life? Yes No  

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


Please review ALL the information provided before you click submit.