| Name |
|
| Age |
|
| Profession |
|
| Name of co-applicant |
|
| Age |
|
| Profession |
|
Address
(Please include City and State) |
|
| Home Phone |
|
| Work Phone |
|
| Cell Phone |
|
| Email |
|
Your household
List names and ages of all human residents in your home. |
|
| Best time to call |
A.M
P.M
|
| Does every member of the household want a new dog? |
Yes
No
|
| If so, why? |
|
| If not, why not? |
|
| Please list the names, breeds, sex, and ages of each canine resident, as well as whether each is spayed or neutered, up-to-date on shots? |
|
| Please list the names, sex, and ages of each feline resident, as well as whether each is spayed or neutered |
|
| Please list the types, names, sex, and ages of each of your other pets, as well as whether each is spayed or neutered |
|
| Please list the names, breeds, and types of pets you have had in the past who are no longer with you and please tell us what happened to them |
|
| Your Home |
I rent my residence.
I own my residence.
your residence?
[We require written approval by your landlord before we can adopt
to those who rent.] |
| Is your residence a |
house
apartment
townhome
condo
other |
| Do you have a fenced yard? |
yes no
[Please note that we require a secure physical fence for all of
our dogs. We will consider waiving this requirement only in cases
of especially calm senior dogs or special needs dogs, but this waiver
is given on a case by case basis. Electric or underground fencing
will not be considered a suitable alternative to physical fencing.] |
| What is the approximate height of your fence? |
feet inches |
| What type of fence do you have (e.g., chainlink, privacy)? |
|
| When will your dog be in your yard? |
|
| How long will the dog be left alone? |
|
| Where will your dog be when your family is home? |
|
| Where will your dog be when your family is not home? |
|
| Where will your dog sleep at night? |
|
| What breed of dog do you wish to adopt? |
(Please check as many breeds as you wish)
Chesapeake Bay Retriever (Chessie)
Curly Coated Retriever
Flat coated Retriever
Golden Retriever
Labrador Retriever
Nova Scotia Duck Tolling Retriever (Toller)
Retriever mix (dogs with more than one retriever breed in them!) |
| What age dog are you seeking? |
Please note: RROC maintains an organization policy specifying that homes for puppies will only be considered under the provision that the puppy be left alone a max of one hour per month of its age. If you work 8 hours, only a dog 8 months or older will be considered. Please do not apply for under 6 months if you are unable to fulfill this requirement.
under 6 months old
6 months to a year
1 to 3 years old
4 to 7 years old
8 years or older
age is not as important as temperament |
| What gender are you seeking? |
male
female
either
Why?
|
| What special needs would you consider? |
(Check all that apply)
inexpensive medication, such as to control thyroid or seizures
physical disabilities
socialization issues, such as shyness
other:
none |
| What will you want to do with the dog? |
(Check all that apply)
gentle exercise on a limited basis
daily walks and play
frequent sustained exercise (runs, long hikes, or dog sports such
as agility or flyball) |
| How will you train the dog? |
informal obedience training at home
enrollment in an obedience class
do not plan to train the dog |
| How will you discipline your dog? |
|
| Who will be responsible for the care and training of the dog? |
|
| Why do you want a retriever? |
|
| When will you be ready for a new dog? |
|
| How did you hear about RROC? |
If "Other Rescue", which one?
If other, please specify:
|
| Is there a certain dog you are interested in? |
|
| Who is your vet? |
|
| Please list three names and contact information of individuals who
do not live with you who can provide information about your treatment
of pets. |
1.
2.
3.
|
|
I would like to be included on RROC's mailing list to receive event updates and the quarterly newsletter |
|
I swear or affirm that the information I have provided is correct to
the best of my knowledge. |
|
I understand that any inaccuracies shall result in my application being
suspended. |
By submitting this information, you agree to:
- Not transporting this dog unconfined in an open vehicle.
- Not leave the dog unattended in any vehicle, as temperatures can escalate to a fatal level within five minutes.
- Regularly check the tightness of any collar and to remove choke chains or other training collars from the dog when the dog is unattended.
- Seek assistance from knowledgeable sources, including but not limited to RROC personnel, veterinarians, behaviorists, or obedience trainers when problems with the dog's behavior arise.
- Comply with all local, state, and federal ordinances, laws, statutes, and regulations concerning animal ownership or guardianship, including but not limited to licensing requirements.
- Provide suitable confinement for the dog. Under no circumstances is the dog to be routinely tethered as a means of confinement.
- Provide for suitable care if the Adopter(s) will be absent from the home.
- Never have the dog wear an electric, electronic, or shock collar for the purpose of using an electric or invisible fence.
|
| I have read and agree to the RROC policies stated above. |
| |
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Adoption