ADOPTION APPLICATION

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BENGAL ADOPTION APPLICATION

For the best match between Bengal and family, as well as to protect our dog, we screen our
applicants carefully. Please read our Terms of Adoption and take the time to answer our questionnaire carefully and thoughtfully. Thank you for your interest in adopting a rescue dog BANGLE!

Name: ___________________________________________

Address: _________________________________________

(Apt.): _________________

City: ________________ State: _______ Zip: ________

Home Phone:(_____)______________________

Work Phone: (_____)______________________

E-mail: _______________________

1) Have you ever owned a Pit Bull? ___________________________________

2) Do you still have that dog? Yes: ___ No: ___ M/F ____ Age: _____

Spayed/Neutered? Yes: ___ No: ___

If no, please explain: ________________________________________

If you have never owned a Pit Bull, have you done some research to learn about the breed?

Yes: ___ No: ___

3) What happened to your last Pit Bull? ______________________________

4) For what purpose do you want this Pit Bull? _________________________

5) Do you have any other animals? Yes: ___ No: ___

If yes, list type, age, and sex: _______________________________

_______________________________________________________

Are cats spayed/neutered? Yes: ___ No: ___

If no, please explain:_____________________________________

6) Do you have children at home? Yes: ___ No: ___

If yes, Number: _______ Age(s): ___________________________

7) Do you live in a house? ___ Apartment? ___ Condo? ___Trailer? ___

8) Do you rent? ___ Own? ___

9) If you rent, do you have the landlord's permission to keep a dog?

Yes: ___ No: ___

If you rent, do you understand the dog must be exercised on a leash in a safe place? Yes: ___ No: ___

10) Do you have a yard? Yes: ___ No: ___ Is it fenced? Yes: ___ No: ___ Good Condition? Yes: ___ No: ___

What type of fencing? Chain ___ Wood ___ Height _____

Other: (please describe) _________________________________

If you have a doggy door, does it open only into the fenced yard? Yes: ___ No: ___

Size of Door? Small: ___ Med:___ Large:___

If you live in an apartment/town home, is there a safe place to walk/exercise the Pit Bull? Yes: ___ No: ___

11) Is someone home during the day? Yes: ___ No: ___

Please explain: ____________________________________________

12) What provisions will be made for your Pit Bull if nobody is home during the day? Loose inside? ___ In crate? ___ In
fenced yard? ___

13) Do you intend to keep the Pit Bull primarily indoors ___ or outdoors ___?

14) Where will the Pit Bull to sleep? Please explain: ________________________

Does everyone in your home want this Pit Bull? Yes: ___ No: ___

15) Are you prepared to assume the financial responsibilities of caring for Bangle, including inoculations, heartworm preventative, veterinarian care, good quality food, licensing, etc.? Yes: ___ No: ___

16) Do you understand that the Bangle must be kept on monthly heartworm and flea preventative? Yes: ___ No: ___

17) Is this Bangle going to be a gift? Yes: ___ No: ___

If yes, for whom? __________________________________________

If yes, does this person know he or she is getting a Pit Bull?

Yes: ___ No: ___

18) When you need to discipline your dog, how would you do it?
________________________________________________________

19) Do you accept the adoption fee of $75.00 payable immediately by check, cash, or money order upon adoption and delivery of the adopted Bengal? Yes: ___ No: ___

I am in full agreement with the Terms of BENGAL'S Adoption . By signing below I am attesting to the truthfulness of my answers. I understand that falsification of any of the above information will be grounds to disallow the adoption of a rescue Bengal.

Date: ________________

Signature: __________________________________

NOTE: If you are under 18 years of age, a parent or guardian must also sign this application. Thank you for considering BANGLE the super pup!