BARK — Bandit's Adoption and Rescue of K-9's

Dog of the Week

Name:	Sky
Breed:	Pit Bull
Age:	1yrs

Adoption Outings

Every Saturday and Sunday
PetSmart at Short Pump Towne Center located at
11740 B West Broad St
Henrico, VA 23233
Saturday: 12:00pm-3:00pm Sunday: 12:00pm-2:00pm (Sunday hours are subject to volunteer availability and weather conditions. Please check the web site for cancellation notices.)
2nd and 4th Saturdays of every month
Petsmart at Cosner's Corner
9751 Jefferson Davis Highway
Fredericksburg, VA 22407
11:00am-2:00pm

Adoption Application

THANK YOU for your interest in adopting a rescued dog or puppy.

Please Note:

1) Confidentiality: This form is designed to help you find the dog or puppy most compatible with your lifestyle. BARK will maintain the information provided below as confidential and will not share your information with any outside individuals or organizations without your express consent. Completion of this application does not obligate you in any way or guarantee the adoption or fostering of a BARK dog or puppy. BARK reserves the right to approve or deny any application for any reason and the right not to disclose the reason.

2) Spay/Neuter: BARK ensures that all adult dogs and puppies are spay/neutered prior to adoption. It is possible that an approved adopter may experience a short waiting period (for spay/neuter to occur) between being approved and being able to take the dog or puppy home. In the event this occurs, we thank you for your patience.

3) Response: A BARK representative will make every effort to contact you regarding your completed application within 3–5 days.

Please complete all the following questions completely to the best of your knowledge.

* NAME(s) and BREED(s) OF DOG that interest you:

Application Inforamtion

*Your Name:

Phone(Work):

Phone(Home):

Phone(Cell):

What is the best time and number to reach you?

Address:

City:

State:

Zip:

*Email ID:

Are you over 21?

Yes No

Occupation:

Employer Name:

Employer Address:

Employer City:

Employer State:

Employer Zip:

Household Inforamtion

Number of Adults in Household:

For all adults in household in addition to applicant, please provide information:

1. First and Last Name:		Occupation:
Employer Name:		Employer Address:
Employer City:		Employer State:
Employer Zip:

Number of Children in Household:

Ages of Children:

How did you hear about BARK?

Short Pump Adoption Event
Previous Adopter
Online
Friend
Newspaper
Other

If Other then Specify:

Are you aware of your county's or city's number of pets you can have in your home?

Yes No

Is this the first dog for you and/or your family?

Yes No

Are all the adults in your household aware that you are adopting a dog/puppy?

Yes No

The primary caregiver for your new dog/puppy?

Does any member of your household have an allergy to dog hair/dander?

Yes No

If adopting, what do you hope that a new dog/puppy will add to your lifestyle?

If you presently have other animal(s), please describe:

No of present animals :


1. Name:		Breed:
Age:		Gender:	Male Female
Spay/Neutered?	Yes No	On vaccinations?	Yes No

Other?

Who is financially repsonsible for your current pets?

Name of your veterinarian:

Veterinarian's phone number:

Veterinarian's Address

City/town of your veterinarian:

Veterinarian's State:

Veterinarian's Zip:

In whose name are these veterinary records?

Is there any additional information about your current pets that you would like us to know?

If you have previously had other animal(s), please complete:

No of previous animals :


1. Name:	Breed:
Years Owned:	Spay/Neutered?	Yes No
Where is this pet now?:
Pet's Veterinarian Information
Veterinarian Name:	Veterinarian Address:
Veterinarian City:	Veterinarian State:
Veterinarian Zip:
Veterinarian Phone Number:

Who was financially repsonsible for these pets?

In whose name are these veterinary records?

Others?

How did you correct the animals listed above, if they had an accident in the house?

The next three questions apply to all adults residing in the house.

Has anyone in your household EVER released a pet to an animal shelter or rescue?

Yes No

Has anyone in your household EVER given a pet away?

Yes No

Has anyone in your household EVER sold a pet?

Yes No

If answered yes to any of the previous three questions, what were the circumstances?

Is there any additional information about your previous pets that you would like us to know?

Lifestyle Information

Please select the temperament and activity level you are seeking in a dog (select all that apply):

Athletic/High Energy
Quiet
Lap-dog
Mellow
Very Affectionate

What type of housing do you live in (detached, town house, apartment, etc.)?

Do you own or rent?

Rent Own

If renting, what is your Landlord's policy on pets?

If renting, what is your Landlord's name:

Phone number with area code:

Do you have a completely fenced yard?

Yes No

If yes, what is the type and height of the fence?

Is there a gate?

Yes No

Is there a pool?

Yes No

If yes, is there a fence around Pool?

Yes No

How many hours each day will the dog/puppy be left alone?

Will the dog/puppy be kept indoors or outdoors when alone?

Will the dog/puppy be crated?

Yes No

In what room will the puppy/dog be kept?

Where will the dog be kept during the day when you are home?

Where will the dog sleep at night?

What type of exercise will you give your dog?

How often?

How many hours a day do you realistically have to exercise or play with your dog?

Are there times when the dog will be tied outside?

Yes No

If yes, when?

If adopting, do you plan on attending obedience classes with your new dog/puppy?

Yes No

If adopting, do you plan on attending obedience classes with your new dog/puppy?

If your new dog/puppy has an accident in the house, how will you correct him/her?

How long do you expect housebreaking to take?

Do you know what causes heartworms in dogs/puppies?

Yes No

Do you agree to keep your dog on heartworm preventative year round?

Yes No

When you go on vacation/travel, who will care for the dog/puppy?

If you move, what will you do with the dog/puppy?

How much are you willing to spend on medical bills for the dog/puppy?

What would you do if the vet bills go over this amount?

Have you ever incurred extraordinary vet expenses?

Yes No

If so, please explain:

Are you ready to take responsibility for this dog for the next 10-15 years?

Yes No

What provisions will you make for the dog should you become unable to care for it?

Have you previously applied to adopt a dog, puppy, cat or kitten from a rescue or shelter?

Yes No

If yes, when did you apply, and what was the name of the rescue or shelter?

What was the result of your application?

Are you willing to have a BARK representative visit where the dog/puppy will be living?

Yes No

Personal Reference of someone not living in your home

1. Name:

Phone Number:

Relationship:

2. Name:

Phone Number:

Relationship:

Is there anything else you feel we should know?

Authorization/Release

By signing (placing your initials on this form) below and submitting this form, I certify that all information given in this application is true and correct, to the best of my/our knowledge. I understand that BARK is a non-profit organization and is offering the Rehoming Assistance Program as a RESOURCE to help animals in need and is in no way responsible or affiliated with the dog or lister/owner of the dog. By submitting this form, I hereby further grant consent to BARK and its agents to seek information about me from all named and unnamed sources within this application, including but not limited to veterinarians, rental agents, and personal references, regarding this application. Providing false information or refusing to sign below will result in the rejection of the application or the nullification of any adoption or foster agreement.

* Signature of applicant (enter your initials):

Signature/initials of second applicant (if applicable):

BARK reserves the right to approve or deny any application for any reason and the right not to disclose the reason.