Your Name*
[text* your-name]
Street Address*
[text* Address id:Address]
City*
[text* City id:City]
State*
[select* dropstate include_blank “AL” “AK” “AZ” “AR” “BC” “CA” “CO” “CT” “DC” “DE” “FL” “GA” “HI” “ID” “IL” “IN” “IA” “KS” “KY” “LA” “ME” “MD” “MA” “MI” “MN” “MS” “MO” “MT” “NE” “NV” “NH” “NJ” “NM” “NY” “NC” “ND” “OH” “OK” “OR” “PA” “RI” “SC” “SD” “TN” “TX” “UT” “VT” “VA” “WA” “WV” “WI” “WY” “NON-US”]
Zip Code*
[text* Zip id:Zip]
Home Phone:
[tel tel-166]
Work Phone:
[tel tel-565]
Cell Phone:
[tel tel-767]
Your Email*
[email* your-email]
Are you applying for Adoption or Foster Care?*
[select* adopt_foster id:adopt_foster include_blank “Adoption” “Foster”]
Are you applying for a specific dog?*
[select* specific id:specific include_blank “Yes” “No”]
If yes, which dog are you applying for?
[text dogname id:dogname]
Are you over 21?*
[select* age21 id:age21 include_blank “Yes” “No”]
Do you rent or own?*
[select* rentown id:rentown include_blank “Rent” “Own”]
What is your current living situation?*
[select* living id:living include_blank “Married” “Single” “Domestic Partnership” “Roommates” “Other”]
How many children reside in your residence?*
[select* kidquant include_blank “None” “1” “2” “3” “4” “5” “6” “7+”]
Please list the ages of children living in your home:
[text kids id:kids]
List others in the home who may have contact with the dog, and their relationship to you:
[text cohabitants id:cohabitants]
Bull terrier gender preference?*
[select* genderpref id:genderpref include_blank “Male” “Female” “No Preference”]
Preferred age range:*
[select* agepref id:agepref include_blank “Puppy” “1 – 5” “5+” “None”]
Why are you interested in adopting a bull terrier over other available breeds?*
[textarea* interest x3 id:interest]
What qualities would you like in a dog?*
[textarea* qualities x2 id:qualities]
What do you NOT want in the pet that you get?*
[textarea* badqual x2 id:badqual]
What do you think the hardest part of having a bull terrier will be?*
[textarea* hardest x2 id:hardest]
What is your occupation?*
[text* occupation id:occupation]
What is your occupation’s daily commitment:*
[select* hours id:hours include_blank “Full Time” “Part Time” “Work From Home” “Retired” “Unemployed” “Other”]
How much time will you spend with your dog?*
[textarea* timewdog x1 id:timewdog]
Where will your dog stay when you aren’t at home?*
[textarea* dogstay x1 id:dogstay]
Where will your dog sleep?*
[textarea* dogsleep x1 id:dogsleep]
Do you have an appropriately sized crate for your dog?*
[select* crate id:crate include_blank “Yes” “No”]
If no, are you planning to acquire one before adopting?
[select crate2 id:crate2 include_blank “Yes” “No”]
How will you exercise your dog?*
[textarea* exercise x1 id:exercise]
How often will you exercise your dog?*
[select* exeroften id:exeroften include_blank “Daily” “Weekly” “Multiple Times a Day”]
Will you be able to socialize your dog through exposure to other socialized dogs? Where, and how? *
[textarea* socialize x1]
What do you know about bull breed dog-on-dog aggression?*
[textarea* aggression x1]
How would you manage this trait in your bull terrier?*
[textarea* manageaggro x1]
Please relate any prior experience you have had with this breed:*
[textarea* experwbreed x1]
Please list other breeds you have had experience with:*
[textarea* otherbreeds x1]
Have you read any publications and websites for information about bull terriers? If so, which ones?*
[textarea* publications x1]
What methods will you use to correct your dog for behaviors you find inappropriate?*
[textarea* methods x1]
Do you currently own any cats?*
[select* owncats include_blank “Yes” “No”]
Do you currently own any dogs?*
[select* owndogs include_blank “Yes” “No”]
Please list your past and present pets, and breed/health/age/neuter status:
[textarea petsinfo x1]
Do you have a yard?*
[select* yard include_blank “Yes” “No”]
If so, type and height of fence:
[text fence]
Do you have a swimming pool?*
[select* pool include_blank “In Ground” “Above Ground” “No Pool”]
If yes, is your swimming pool fenced or covered?
[select poolfence include_blank “Yes” “No”]
If your pool is not fenced/covered, would you be willing to cover/fence it?
[select poolfenced include_blank “Yes” “No”]
What will you do with the dog when you go on vacation?*
[textarea* vacation x1]
If you have to move, what would you do with the dog?*
[textarea* move x1]
Have you ever taken a puppy through puppy class or an adult dog through obedience class?*
[select* classes include_blank “Yes” “No”]
Which trainer/school would you take your dog to?
[text school]
Please provide the name, address and phone number of your vet:*
[textarea* vetinfo x1]
Please supply the name and phone number of a credible reference (employer, clergyman, etc.)*
[textarea* reference x1]
Please provide any additional information you think is important:*
[textarea* additional x3]

[submit “Send”]

APP: [your-name], [City], [dropstate], [rentown], [adopt_foster], Dog Choice: [specific] [dogname], Cats: [owncats], Dogs: [owndogs], Kids: [kidquant]
Adoption Application: [your-name] <[your-email]>
Name [your-name]
Street Address [Address]
City [City]
State [dropstate]
Zip Code [Zip]
Home Phone: [tel-166]
Work Phone: [tel-565]
Cell Phone: [tel-767]
Your Email (required) [your-email]
Are you applying for Adoption or Foster Care? [adopt_foster]
Are you applying for a specific dog? [specific]
If yes, which dog are you applying for? [dogname]
Are you over 21? [age21]
Do you rent or own? [rentown]
What is your current living situation? [living]
Do you have children, if so how many?
[kidquant]
Please list the ages of children living in your home: [kids]
List others in the home who may have contact with the dog, and their relationship to you: [cohabitants]
Bull terrier gender preference? [genderpref]
Preferred age range: [agepref]
Why are you interested in adopting a bull terrier over other available breeds? [interest]
What qualities would you like in a dog? [qualities]
What do you NOT want in the pet that you get? [badqual]
What do you think the hardest part of having a bull terrier will be? [hardest]
What is your occupation? [occupation]
What is your occupation’s daily commitment: [hours]
How much time will you spend with your dog? [timewdog]
Where will your dog stay when you aren’t at home? [dogstay]
Where will your dog sleep? [dogsleep]
Do you have an appropriately sized crate for your dog? [crate]
If no, are you planning to acquire one before adopting? [crate2]
How will you exercise your dog? [exercise]
How often will you exercise your dog? [exeroften]
Will you be able to socialize your dog through exposure to other socialized dogs? Where, and how? [socialize]
What do you know about bull breed dog-on-dog aggression? [aggression]
How would you manage this trait in your bull terrier? [manageaggro]
Please relate any prior experience you have had with this breed: [experwbreed]
Please list other breeds you have had experience with: [otherbreeds]
Have you read any publications and websites for information about bull terriers? If so, which ones? [publications]
What methods will you use to correct your dog for behaviors you find inappropriate? [methods]
Do you currently own any cats? [owncats]
Do you currently own any dogs? [owndogs]
Please list your past and present pets, and health/age/neuter status: [petsinfo]
Do you have a yard? [yard]
If so, type and height of fence: [fence]
Do you have a swimming pool? [pool]
If yes, is your swimming pool fenced or covered? [poolfence]
If your pool is not fenced/covered, would you be willing to cover/fence it? [poolfenced]
What will you do with the dog when you go on vacation? [vacation]
If you have to move, what would you do with the dog? [move]
Have you ever taken a puppy through puppy class or an adult dog through obedience class? [classes]
Which trainer/school would you take your dog to? [school]
Please provide the name, address and phone number of your vet: [vetinfo]
Please supply the name and phone number of a credible reference (employer, clergyman, etc.) [reference]
Please provide any additional information you think is important: [additional]

—
This e-mail was sent from a contact form on Bull Terrier Rescue, Inc. (http://www.bullterrierrescue.org)
applications@bullterrierrescue.org

1
APP: [your-name], [City], [dropstate], [rentown], [adopt_foster], Dog Choice: [specific] [dogname], Cats: [owncats], Dogs: [owndogs], Kids: [kidquant]
Adoption Application: [your-name] <[your-email]>
Name [your-name]
Street Address [Address]
City [City]
State [dropstate]
Zip Code [Zip]
Home Phone: [tel-166]
Work Phone: [tel-565]
Cell Phone: [tel-767]
Your Email (required) [your-email]
Are you applying for Adoption or Foster Care? [adopt_foster]
Are you applying for a specific dog? [specific]
If yes, which dog are you applying for? [dogname]
Are you over 21? [age21]
Do you rent or own? [rentown]
What is your current living situation? [living]
Do you have children, if so how many?
[kidquant]
Please list the ages of children living in your home: [kids]
List others in the home who may have contact with the dog, and their relationship to you: [cohabitants]
Bull terrier gender preference? [genderpref]
Preferred age range: [agepref]
Why are you interested in adopting a bull terrier over other available breeds? [interest]
What qualities would you like in a dog? [qualities]
What do you NOT want in the pet that you get? [badqual]
What do you think the hardest part of having a bull terrier will be? [hardest]
What is your occupation? [occupation]
What is your occupation’s daily commitment: [hours]
How much time will you spend with your dog? [timewdog]
Where will your dog stay when you aren’t at home? [dogstay]
Where will your dog sleep? [dogsleep]
Do you have an appropriately sized crate for your dog? [crate]
If no, are you planning to acquire one before adopting? [crate2]
How will you exercise your dog? [exercise]
How often will you exercise your dog? [exeroften]
Will you be able to socialize your dog through exposure to other socialized dogs? Where, and how? [socialize]
What do you know about bull breed dog-on-dog aggression? [aggression]
How would you manage this trait in your bull terrier? [manageaggro]
Please relate any prior experience you have had with this breed: [experwbreed]
Please list other breeds you have had experience with: [otherbreeds]
Have you read any publications and websites for information about bull terriers? If so, which ones? [publications]
What methods will you use to correct your dog for behaviors you find inappropriate? [methods]
Do you currently own any cats? [owncats]
Do you currently own any dogs? [owndogs]
Please list your past and present pets, and health/age/neuter status: [petsinfo]
Do you have a yard? [yard]
If so, type and height of fence: [fence]
Do you have a swimming pool? [pool]
If yes, is your swimming pool fenced or covered? [poolfence]
If your pool is not fenced/covered, would you be willing to cover/fence it? [poolfenced]
What will you do with the dog when you go on vacation? [vacation]
If you have to move, what would you do with the dog? [move]
Have you ever taken a puppy through puppy class or an adult dog through obedience class? [classes]
Which trainer/school would you take your dog to? [school]
Please provide the name, address and phone number of your vet: [vetinfo]
Please supply the name and phone number of a credible reference (employer, clergyman, etc.) [reference]
Please provide any additional information you think is important: [additional]

—
This e-mail was sent from a contact form on Bull Terrier Rescue, Inc. (http://www.bullterrierrescue.org)
suz@bullyhaven.org

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