Adoption Application

You and Your Family

How did you hear about Big Red Rescue of the Heartland?
Please enter a Referral Name, other Rescue Organization, Search Engine, Petfinder, Event you attended, from our Facebook page, etc...

(you must be at least 21 years of age to fill out an application)
First Name *

Last Name *

Email *

Address: *

City *

State *

Zip *

Home Phone *

Cell Phone

Work Phone

People residing in your household and age of each? Please list *

Your Home

Please choose one *

Home Owner

Rental House

Apartment

Other Other

If you are renting your house or apartment, do they allow dogs?

Yes

No

N/A

We prefer a securely fenced yard for our pets. Is your yard or a portion of your yard securely fenced? *

Yes

No

Please choose fence type

Please choose fence height

Dog Preferences

If you are interested in a specific animal please state the animal’s name:

Describe what you feel are the characteristics of the ideal pet for you & your family. *

Would you consider a animal with special medical needs? (for example, a dog that requires daily medication for a treatable condition) *

Yes

No

Would you consider an animal who has a history of neglect/abuse & who is very shy and needs extra love & attention to trust people? Puppy mill dogs often come to us and need extra TLC and help, we have information & training resources to help you. *

Yes

No

Are you willing to work with a dog who is not fully potty trained? Many of our dogs come from puppy mill situations and require TLC to learn how to live in a home environment. *

Yes

No

Are you prepared for the cost of both routine (worming, annual shots, dentals) and non-routine/emergency veterinary care, especially as the pet gets older? *

Yes

No

Care and Responsibility

Approximately how many hours a day will your new pet be left alone? *

Who in your home will have primary responsibility for the care of the new pet? *

How long will the new pet be left outside? *

Where will the new pet sleep at night? *

How will you discipline the new pet? *

What will you do if your spouse, children, or pets can't get along with the new pet? *

Are all pets living in your home current on vaccinations? *

Yes

No

No pets are currently living in my home

If you answered "no", please give details as to why pets are not current on vaccinations.

Are all pets living in your home spayed or neutered? *

Yes

No

No pets are currently living in my home

If you answered "no", please give details as to why pets are not fixed.

Do you give your dogs heart worm preventative every month? *

Yes

No

No dogs are currently living in my home

If you answered "no", please give details as to why dogs are not on heart worm preventative.

History of Pet Ownership

What animals currently live in the household as your own personal pets or as fosters?
Please list type of animal, gender, age, & how long you have cared for them. *

Please list any dog that you have owned in the past.
Please include the breed, how long you owned them, what age did they pass, and how did they pass. If they are still living, please give details as to why dog is no longer part of your family. *

If you have ever owned a pet that was lost, stolen, or killed in an accident...please explain the circumstances.

References

Please provide three names as references; your first MUST BE your veterinarian.
You must include your landlord (if you rent your home or apartment) as a 3rd reference.

Your references will be checked! Your application will be considered incomplete if references & contact information are not included

Reference #1 -
Must Be Your Veterinarian -
(If this is your first dog, we can recommend a wonderful vet in your area)
Name / Phone Number *

If you have been with your current vet for less than a year, please include the name and phone number of your previous vet
Name / Phone Number

Reference #2 -
Name / Relationship / Phone Number *

Reference #3 - provide only if you rent -
Must Be Your Landlord if You Are a Renter
Name / Phone Number

All of the information I have provided is true and complete, to the best of my knowledge. Should an animal be placed with me, it will reside in my home as a pet. I agree to provide the pet with adequate food, water, shelter, affection, and medical care.

Please Sign *

Please note: If you are applying for a specific animal, we cannot guarantee that the animal will be available. We may receive more than one application for any particular animal and the first application that we receive will be the first one to be reviewed for adoption. In that event, we will still process your application and begin the approval process for you to adopt. We would love to introduce you to some of our other available animals who need loving homes.

Comments or Questions for Big Red Rescue of the Heartland?