OUT OF THE PITS - A NON-PROFIT ANIMAL RESCUE ORGANIZATION

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We're happy that you are interested in adopting an American Pit Bull Terrier, and we want to provide you with a dog that is well matched to your situation. Understandably, we also want to provide the dog with the very best home possible. To that end, we have compiled a detailed questionnaire to help us with our endeavor. Yes- it is long- and will take some time to complete. We hope that you think it's well worth the effort. Please answer every question. If any of the questions are left unanswered the application will not be accepted.

Please complete the following information:

First Name:

Last Name:

Street Address:

Apt.# (if any):

City:

State:

Zip Code (+4):

What is your home telephone number: Area Code: Number:-

What is your work telephone number: Area Code: Number:-

What is your cell phone number: Area Code: Number:-

e-mail address:

At present I am:

How long have you lived at the address above? (pick answer closest to actual time)

Do you have a fenced yard? YES NO

Do you have a fenced kennel area? YES NO

How high is the fence? (pick closest option)

Do you own or rent your residence? OWN RENT

Answer the following section ONLY if you rent-
Does your landlord allow dogs? YES NO

If you rent, please provide your Landlord's Name, Address and Telephone Number:
First Name:		Last Name:

Street Address:

Apt.# (if any):

City:

State:

Zip Code (+4):

Landlord's Area Code: Landlord's Number:-

Age Group of Applicant (you):

Including yourself, how many adults (18 yrs. & older) in household?

How many children in household?

Age of youngest (or only child) in nearest years:

Age of eldest child:

If you do not presently have children, will you keep this dog if you decide to have a family? YES NO UNKNOWN

Are there other pets in the household?

YES

If "yes" please complete the area below:

Species-------------Breed--------------------------------Age---------Gender------Spayed/Neutered?(Y-N)--------

Please describe any previously owned pets:

Species-------------Breed--------------------------------What happened to the animal?-----------------------------

Veterinarian Information:
Vet's Name:

How long have you used this veterinarian?

Area Code: Number:-

Which sex dog would you prefer to adopt? MALE FEMALE UNDECIDED

What are the qualities that you like in this breed:

Are you familiar with the characteristics and temperament of the American Staffordshire/Americal Pit Bull Terrier? YES NO

What age dog would you prefer? (Check all that apply)
PUPPY ADULT UNDECIDED

Where will this dog spend its day? (Check all that apply)
Loose indoors In a crate Basement Garage Fenced yard
Kennel run Tied outdoors Other- describe below

Where will this dog spend its night? (Check all that apply)
Loose indoors In a crate Basement Garage Fenced yard
Kennel run Tied outdoors Other- describe below

Approximately how many hours will the dog be left alone each day?

Why do you want to adopt an American Pit Bull Terrier? (Check all that apply)
Companionship Guard dog Gift Personal protection Child's companion

Please explain in detail your idea of the American Pit Bull Terrier that would best fit in your home, and elaborate on the reasons why you want to adopt an American Pit Bull Terrier.

Are you willing to work with us on problem issues with this dog, should they arise?
YES NO UNKNOWN

Describe for us your dog training experience: (be as specific as possible)

How will you discipline your dog? (be as specific as possible)

Is there anyone in the household that may be adversely affected by a dog? (For example- allergic reactions...)
YES NO

Additional comments of information you wish to submit

Provide two unrelated personal references that we may check:
First Name:		Last Name:

Area Code: Number:-


First Name:		Last Name:

Area Code: Number:-

In the absence of my signature, by submitting this form to Out Of The Pits, Inc. I certify that all the above information is correct; that the dog I adopt will reside in my home as a pet; that I will consistently provide the dog with proper nutrition, water, training, attention, medical care and my love and affection; I will treat this dog kindly and not subject it to cruelty or abuse. I also understand that I will pay a non-refundable adoption fee of One Hundred and Fifty Dollars ($150.00) to Out Of The Pits, Inc. at the time of adoption.