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Incomplete applications will not be considered.
This questionnaire is intended to be a guide to help you think about all the ways a Rottweiler will impact your life and also to determine if a Rottweiler is the right breed for you. All of the questions concern various aspects of dog ownership that should be given serious consideration before deciding to share your life with any dog. The information you provide on this application will help us to find the most suitable dog for your family. Please complete every question.
Is there a particular dog you are interested in? Yes No
Name of the dog:
Name: Age:
Address:
City: State: Zip:
Email Address: Home Phone Number:
Employer:
Hours at work:
Spouse/Significant Other: Age:
Children living at home:
If you do not have children, do you plan to have children some day? Yes No If yes, explain how this will affect the dog's place in the household:
Does anyone else live in your home? Yes No
Name: Relationship: Age:
Does anyone in your home have allergies or asthma: Yes No
Your Residence:
Which of the following best describes your living situation:
House Condo Mobile Home Apartment Other
Type of environment: City Suburb Country
Do you: Own Rent Live with Parents
If you rent, Please provide your landlord's name, address and phone number:
Renters must provide a statement from their landlord indicating that a Rottweiler may live on the premises.
How long have you lived at this address?
Name of Homeowner Insurance company:
Do you have a fenced yard? Yes No
Type and height of fence: Is the gate padlocked? Yes No
If you do not have a fenced yard, are you prepared to walk your dog on a leash for potty breaks and exercise 3 or more times per day, regardless of the weather conditions or time of day/night? Yes No
Do you have a pool? Yes No Is it fenced separately? Yes No
What is the maximum number of dogs/pets allowed by city ordinance?
Does your Homeowners Association allow Rottwieler's? No Yes
What are your local licensing fees/requirements?
Is there a chance you might move in the next 10 years? Yes No
If so, are you willing to restrict your choice of housing to places where a Rottweiler is allowed? Yes No
What type of vehicle do you have?
Where will the dog ride?
Care and Responsibility
What steps have you taken to learn about Rottweilers and dog ownership?
Have you ever owned a Rottweiler? Yes No
Do you prefer a male or female Rottweiler? Male Female
Why?
Age range: Puppy Teen Young Adult Adult Mature
Will you accept a Rottweiler with special medical needs? Yes No
Will the Rottweiler serve as a guard dog? Yes No
If you answered yes to the above question please explain:
Where will the dog be kept? Inside Outside Other (specify):
Where will the dog sleep at night?
How many hours per day will the dog be left alone?
Do you plan on crate training your dog? Yes No
Will you take your dog to obedience class? Yes No
What types of activities will your Rottweiler participate in?
What types of behavioral/training issues are you prepared to deal with?
Chewing Yes No
Housebreaking Yes No
Barking/Whining Yes No
Marking Yes No
Leash Pulling Yes No
Nipping/Mouthing Yes No
Food Aggression Yes No
Pack Dominance Yes No
Chasing Cats Yes No
Digging Yes No
Jumping on People Yes No
Resource Guarding Yes No
Do you understand that the dog will take time to adjust to its new surroundings and that certain behavioral issues might occur? Yes No
Are you willing to work to correct these issues? Yes No
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? Yes No
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?
Veterinarian Name and Telephone Number:
Names of animals seen at that vet clinic:
Are your pets current on vaccinations? Yes No
Are your dogs on heartworm preventive medication? Yes No
Brand If no, why not?
If you have pets that are not spayed or neutered, please explain why:
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?
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.
Name: Phone Number:
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. The Adopter will also make an adoption payment of $150 to $300 to LaP Dog Rescue upon taking possession of the dog. LaP Dog Rescue reserves the right to make future 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.
LaP Dog Rescue 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: