Rogers' Rescues Adoption Application

Use the TAB key to move from field to field.

We realize this application is lengthy, but having all of this information helps us to match you with a dog that will fit your family and lifestyle, and it increases the chances of the dog finding its' forever home, and that's what rescue is all about!  Please read this entire application thoroughly and fill it out completely. Incomplete applications will be discarded.

PLEASE NOTE: Required fields are indicated by *

If applying for a specific dog, please list the dog's name:

About You:

*  Full Name: CoApplicant Name
* Home Address (include street address, city, state, zip):
* County:
*  Home Phone
(ex: 610-123-4567) 		*  Cell Phone
(ex: 610-123-4567) 		*  Best Time to Call

Enter Email Address: Example: Fido@aol.com
*  Email Address *  Verify Your Email Address
*  How long have you been looking for a dog?
*  How did you hear about Rogers' Rescues ?
Is the dog you are applying for going to be a gift?
Yes
No

About Your Household:
*  Names and Ages of all adults in the household:
*  Ages of Children in the household
* Is anyone in your home allergic to animals?
       No    Yes, please explain

*  Are you familiar with animal regulations in your area?
Do you rent or own? Rent Own

If you rent, you must have a written letter from your landlord stating that you are allowed to have dogs. Please have this letter or a copy of your lease faxed to 732-875-1290. We cannot process this application without your landlord's letter.

 

*  Are you planning to change residence in the near future?
*  Please briefly describe your home
Do you have a yard? Yard, Fenced Yard, not fenced No yard
*  Please briefly describe your yard, including type of fence, if applicable
*  Do you have an outside dog run? No Yes
If so, please describe (if you didn't already describe it above)
Do you work? Yes No Telecommute/work at home
*  How many hours will this dog be left alone during a typical day?

About your dream dog:
*  Tell us which dog you're applying for, and/or describe your "dream dog." Include anything that's important to you: breed, size, temperament, age, etc.

What training issues are you willing to deal with in an adopted dog? In other words, will you have the time/desire to work through the following? (Please check all that you feel you can handle.) If we have observed any of these issues in a foster dog, it will be noted in their Petfinder listing and/or the foster home will discuss them with you when they contact you.

I will happily work through the following issues with my adopted dog (and a trainer if necessary): Please be honest. If you don't want to deal with any of these issues, please don't check the box:

Housebreaking Chewing Basic Obedience Leash Training
Fear of adults/children/men/women Issues with other dogs Submissive peeing
Separation anxiety Counter surfing (stealing food off counters
*  If you are having bothersome behavorial issues with your dog after the adoption, will you hire a private trainer to assist you and your dog in working through these issues? Yes No, Explain below

Check all that apply:

I AM willing to deal with known medical special needs at the time of adoption (examples: blindness, deafness, need for medications, diabetes, arthritis)
I MAY be willing to deal with known medical special needs at the time of adoption
I AM NOT willing to deal with known medical special needs at the time of the adoption
Should my adopted dog develop special needs over time, I will still keep this dog, get proper veterinary care, and follow my vet's guidelines, including whatever treatments/medications/special foods are required

About ongoing responsibilities:

*  How much do you think it costs to feed, house, and care for a dog, including veterinary expenses, food, toys, bedding, leash, collar, etc. for one year?
Will you assume all financial responsibilities for the dog you adopt including inoculations, regular veterinary care, good quality food, licensing, ID tag, dog bed, leash, collar, etc.? Yes No
*  Describe what is meant be regular veterinary care
*  Has any pet in your care ever been hit by a vehicle? No Yes, Explain below
*  Please describe a typical day in the life of your new dog. Include things such as where the dog will sleep, when the dog will eat, when and how the dog will exercise, and who will make sure that the dog has what she/he needs
Do you understand that any dog you adopt from Rogers' Rescues will have to be or may have already been spayed/neutered? Yes No
If you are adopting a puppy and it is not already spayed/neutered at the time of adoption, you will be required to have this surgery done at your own expense by 6 months of age. All adult dogs are altered by our rescue prior to adoption unless they cannot be altered for medical reasons (verified by our vet).

About your current and former pets :
*  Do you have any pet(s) currently? List type, breed, age, sex, and approximate weight, and describe their general personality. Be sure to include whether or not current pets have interacted with dogs in the past.

Veterinary Information:
*  Current Vet
If you don't currently have a vet, list a former vet or the vet you plan to use if you adopt.
*  Vet's Address (include street address, city, state, zip)
*  Vet's Phone Number


If you currently have pets, please have your vet fill out and fax our vet fax form to us at 732-875-1290. We cannot process your application without this information. You will be directed to the form after you click "Submit" on this application.

Former Dogs:
Have you had dogs in the past? No Yes
*  Please describe dogs you've had in the past and your history with them. Include breeds, training you did with them, and why they're no longer with you

About the people who say you would be a good dog parent:

References: (Full contact info, including email address, is required)
Reference CANNOT be someone who is related to you.

PLEASE NOTE: Even though you are giving us the contact information for your references, it is YOUR responsibility to contact your references and ask them to send an email to us. Further instructions ban be found on the next page.

Reference #1:
*  Name
*  Relationship to you
*  Email address
*  Verify email address

Reference #2:
*  Name
*  Relationship to you
*  Email address
*  Verify email address

Application Agreement

Please read before signing!
It is your responsibility to contact your references and request that they send an email to us. However, by signing below, you are giving permission for Rogers' Rescues to use the information on this application to contact your references and veterinarian if needed, and you give permission for your veterinarian to release your pets' medical records to our rescue, if necessary.

Please check the box below, to certify that this is your electronic signature, and that it is binding on this application. You further certify that the information you supplied in this application is true. You understand and agree that falsification of any of the above information or any information disclosed during the review process is grounds to disqualify your adoption application and nullify all adoption(s) and/or adoption agreements between the applicant and Rogers' Rescues.

I/We have read and understand all of the above.
*  Applicant's Signature
* Date (ex: mm/dd/yyyy)
Co-applicant's Signature
Date

When you're sent to the next page, please print and save that page so you can read it thoroughly and refer back to it. Thank, if you currently have pets, click the link through to our vetting page.

Please click submit only once. It may take a few seconds to go to the next page!

THANK YOU!!!