First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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Email*

Home Phone

Work Phone
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Cell Phone*

Alt Email

Occupation*

Are you at least 18 years of age?*

Have you ever adopted an animal from Redemption Road Rescue before? *

If you are interested in a particular animal, please specify who:
Choose an animal: *DOG FOSTERS NEEDED* Bailey **URGENT FOSTER NEEDED** Bristol Bay Buddy Chappie *FOSTER HOME NEEDED* Cheeto Chester Chiwi and Goku Divine Elena Emory Ferrari Ford Jaguar & Jetta Jan The Man Jeffrey Kimberwick (FeLV+, FIV+) Layla *FOSTER HOME NEEDED ASAP* Leo Lexus Little Girl Luna M Maddie Martha Molly *FOSTER HOME NEEDED ASAP* Nesta & Azriel Rambler Rex *FOSTER HOME NEEDED* Rusty Rza Sadie Sigmund ("Siggy") *Pending Adoption* Turbo **FOSTER NEEDED** Winnie

Why do you feel this animal would be a good addition to your family? What made you choose this animal?*

If the dog you are interested in is no longer available, are you open to hearing about other potential matches from our Dog Coordinator?

What characteristics are you looking for in an animal? Any particular gender or age?*

Why are you looking for a new companion animal?

How many ADULTS are in the home? Please list their names and their relationship to you. *

How many kids under 12?*

How many hours per day will your dog spend ALONE?

How many consecutive hours per day will YOU be gone?*

Shelter dogs may not be kennel trained or may insist on not using one due to their past. How do you plan to keep your dog safe without a create?*

Where will the dog be kept when no one is home?*

Does anyone in your household smoke inside the home?*

If yes, how will keep the animal safe from second hand smoke?

Type of Dwelling

Is your yard completely fenced & enclosed?

Fence Height & Material

If you do not have a fenced in yard, how do you plan to keep your new dog safe?

Please tell us about your current dog(s), and/or cat(s), if any. List the following information for each animal you currently own: Name, breed, sex, age, whether or not the animal is fixed (altered), and whether or not they use flea & tick preventative. *

Do you own or rent your home?

If you rent or have an HOA, please give name, phone number, and email address of landlord or HOA:

Are you planning on moving? If so, when?*

Are there any weight or breed restrictions?

If so, what are the restrictions?

Are you aware of the animal leash, license, and rabies laws in your area?

What kind of research have you done on the breed of dog you are interested in adopting? How and why do you believe this dog will will fit into your lifestyle?*

How will the dog get its daily exercise?*

How will you plan on training & disciplining the dog? Please elaborate:*

Some dogs need/enjoy having another dog in the home for companionship. Would you be interested in fostering or adopting another dog in the future?*

Do you agree to contact RRR before privately rehoming an animal? Do you also agree to not bring this animal to a shelter?

Please list any pets you have previously owned, along with the following information: Breed/species, how long the pet was owned, was it kept indoors or outdoors, was it spayed/neutered, and where the pet is now (if deceased, please list cause of death).

Have you ever moved from one residence to another without taking your pet? Please explain the situation:*

Have you ever had to give a pet up? If so, please tell us why?*

Under what conditions would you not keep your new pet?*

What is the name and location of the vet you are seeing/will be seeing?*

Will you be using a Heartworm Preventative?

Do you plan on using flea preventative regularly?

It is very common for animals to have accidents in their new home as they get acclimated to their new environment and schedule. Do you understand it may take your pet anywhere between 2 weeks to 6 months to adjust to its new surroundings and for its true personality to emerge?

Submitting an Adoption Interest Form does not guarantee a meet & greet or adoption. Please initial for acknowledgement. *

Please list two NON-FAMILY personal references, their relationship to you, and their phone or email. *

E-Signature: I, the undersigned, attest that, to the best of my knowledge, the above information is accurate and complete at the time of signing. I understand that falsely provided information can mean that my application will be terminated.*