Personal info:

Name:

Age:

Address:

City/State/Zip:

Email Address:

Your Employer:

Home Phone:

Work Phone:

Cell Phone:

Hours at Work:

Spouse/Significant Other Name:

Spouse/Significant Other Age:

Spouse/Significant Other Employer:

Spouse/Significant Other Work Phone:

Spouse/Significant Other Hours at Work:

Children living at home:

Child #1 Name/Age:

Child #2 Name/Age:

Child #3 Name/Age:

Child #4 Name/Age:

Child #5 Name/Age:

If you do not have children, do you plan to have children some day?

If yes, explain how this will affect the dog's place in the household:

Does anyone else live in your home?

Person #1 Name/Relationship/Age:

Person #2 Name/Relationship/Age:

Person #3 Name/Relationship/Age:

Does anyone in your home have allergies or asthma:

Your residence:

Living situation:

Type of environment:

Do you:

If you rent, please provide the following:

Landlord's Name:

Landlord's Phone Number:

Renters must provide landlord statement indicating that a Rottweiler may live on the premises.

How long have you lived at this address?

If < 2 years, previous address and landlord:

Name of Homeowner Insurance company:

Insurance Agent Name:

Insurance Agent Phone Number:

Do you have a fenced yard?

Type and height of fence:

Is the fence secured underground?

Is the gate padlocked?

Do you have a pool?

Is it fenced separately?

What is the maximum number of dogs/pets allowed by city ordinance?

What are your local licensing fees/requirements?

Is there a chance you might move in the next 10 years?

If so, are you willing to restrict your choice of housing to places where a Rottweiler is allowed?

Care and Responsibility:

Is there a particular dog on our website that you are interested in?

Dog Name:

What steps have you taken to learn about Rottweilers and dog ownership?

Have you ever owned a Rottweiler?

Do you prefer a male or female Rottweiler?

Why?

Age range:

Will you accept a Rottweiler with special medical needs?

Will the Rottweiler serve as a guard dog?

Where will the dog be kept?

Where will the dog sleep at night?

How many hours per day will the dog be left alone?

Do you own a dog crate?

If no, are you willing to purchase one?

Will you take your dog to obedience class?

What types of activities will your Rottweiler participate in?

What types of behavioral/training issues are you prepared to deal with?

Chewing

Housebreaking

Barking/Whining

Marking

Leash Pulling

Nipping/Mouthing

Food Aggression

Pack Dominance

Chasing Cats

Digging

Jumping on People

Resource Guarding

Do you understand that the dog will take time to adjust to its new surroundings and that certain behavioral issues might occur?

Are you willing to work with SSRR to correct these issues?

Under what circumstances might you want to return your dog? (Examples: Marriage, new baby, divorce, behavior issues, financial stress, moving, job change, etc.)

History of Pet Ownership:

Do you currently have other pets?

If yes, please describe each pet in detail (species, age, breed, sex, spayed/neutered, personality):

If you currently have a dog or dogs, what is the extent of their obedience training?

If you have never had Basic Dog Obedience Training for a large breed dog, SSRR will assist you in finding an approved course. It is mandatory that within 30 days of adoption that a Structured Basic Dog Obedience Course be scheduled. The class must be completed within the first 90 days of the adoption. All dogs under the age of 1 year old are required to take Basic Obedience Training. Certificate of Completion of "Obedience Class" will need to be sent to SSRR.

Veterinarian Name:

Veterinarian Phone:

Names of animals seen at that vet clinic:

Are your pets current on vaccinations?

Are your dogs on heartworm preventive medication?

Brand If no, why not?

If you have pets that are not spayed or neutered, please explain why:

Have you ever had a pet hit by a car?

Please list all the animals you have owned in the past 10 years and what happened to them:

What do you enjoy most about dog ownership?

What do you like least about dog ownership?

List any Humane Societies, Kennel Clubs, Breed or Training Clubs you are associated with:

References:

Please list the names and telephone numbers of 3 references not related to you. If you do not currently have pets under vet care, please provide a 4th reference.

Reference #1 Name/Phone Number:

Reference #2 Name/Phone Number:

Reference #3 Name/Phone Number:

Reference #4 Name/Phone Number:

How did you learn about SSRR?

By signing below, Applicant certifies that the above information is true and understands that, prior to being approved for adoption, this information will be verified. A home visit will be scheduled and all members of the household must be present. Applicant certifies that he/she is financially and physically able to care for the animal. Applicant understands that proper food and vet care can be costly and is prepared to meet these requirements. The adopted Rottweiler will be spayed/neutered, current on vaccinations and on heartworm preventive medication prior to placement. Approved adoptions require a signed Adoption Contract. Adopter will also make a tax-deductible donation of $250 to SSRR upon taking possession of the dog. SSRR reserves the right to make random visits to ensure the adopted dog is being properly cared for, and if it is not, to remove the dog from the premises without refund.

SSRR reserves the right to decline any application.

"I/we hereby state that neither I/we nor anyone in my/our household, nor anyone who will have access to or care for this dog, has ever been charged with or convicted of any offense involving animal neglect, abuse, or cruelty, regardless of any dismissal or deferred prosecution or other expunging of the records. I/we understand and agree that if this statement is found to be incorrect, without further evidence of any other contract violation, the Rescue may immediately obtain return of all animals adopted to me/us, without refund of any sums paid, donated, or expenses incurred. Further, it is agreed that I/we shall pay all costs of the recovery and return of said dog(s) incurred by said Rescue."

Signature (re-type email address):