Adoption Application, Please read this first.  Adoption Fees.

Date:

First and Last Name

Address

CityStateZip

Daytime Phone 

Nighttime Phone

Email Address

We will be contacting you by e-mail

Employer: 

City:

How long:: 

Phone:

Spouses Employer: 

City:

How long:: 

Phone:

Please List 2 References:

Name

Address

CityStateZip

Phone 

Name

Address

CityStateZip

Daytime Phone

These questions help facilitate the best home for the Jack Russell's we have in the rescue. We want to make sure the JRT you are interested in, is the best match for your home.

1) Is there a particular JRT that we have that you are interested in?

Please check your preference:    Male      Female     No preference

2) Do you have a color and coat preference? (Check all that apply) White/Red    White/Brown    All White    White/Tri    White/Tan    No preference

2A)Smooth Coat    Broken Coat    Rough Coat     No Preference on coat

3) Do you have an age preference? (Check all that apply)    Under 1 year    1 - 2 years    2 - 4 years    Over 4 years    No Preference

4) Who is the Jack Russell for?

5) Have you owned a Jack Russell or any dog before? If YES, please give a brief history: No   Yes   

6) What is it about Jack Russell Terriers that interest you?

7) What other breeds have you considered?

8) Check the 3 most important characteristics that you would like to see in your Jack Russell.  Active    Playful    Independent    Protective    Dominant    Intelligent    Loving    Shy    Aggressive    Submissive    Other: (describe)

9) How do you plan to discipline your dog?

Please read: To facilitate the bonding process, we highly recommend that every new Jack Russell undergo some introductory obedience training.

10) Will you train your new rescued dog in basic obedience? (Check one)    YES        NO

If no, explain

11) Which of the following best describes your current residence? (Check one) Own House    Rent/Lease House    Own Townhouse/Apartment    Rent/Lease Townhouse/Apartment                Other (describe)

NOTE: If you rent or lease your residence, proof of permission to own dogs will be required before the adoption is finalized

12) Do you have a fenced yard or a secure dog run? (Check one)    YES       NO 

If YES, please describe fence: (example; type, height)

Number of Gates: Can children easily open the gates? YES    NO

13) What improvements, if necessary, will you make to secure your yard?

14) If you do not have access to a fenced area at your home, would you like a rescue representative to provide recommendations on the safe confinement of your dog?  YES    NO I have already made the following arrangements:

15) Have you checked your yard for dangerous articles, plants or anything the dog could use to climb the fence? YES    NO   

16) Would you like some assistance from a rescue representative?  YES    NO

 

 Would you object to a rescue representative doing a home visit with the rescue dog?  Required field, yes or no

We want to make sure the dog gets along in your environment before we place him/her.  

17) If you have a pool, is it fenced? If no pool leave blank.  YES    NO

18) Do strangers (meter readers, etc.) require access to the area your dog will occupy?  YES    NO

19) Are there any distractions outside the yard that may upset the dog?   (Neighbor's dog, loose dogs on street, neighborhood children, etc.) YES     NO

20) Approximately how many hours each day will your dog be alone?   (Check one)

3 hours or less     3 and 6 hours    6 and 9 hours     9 to 12 hours 12 and 18 hours     Longer than 18 hours

21) How will your dog be confined when left home alone?

22) Will the dog be kept primarily  indoors  or  outdoors? 

23) Where will the dog sleep at night?

26)  Does anyone in your family have allergies to dogs?  YES     NO

27) Who will have primary responsibility to care for the dog?

27A) If you have chosen a child to care for the dog, who will be the second caretaker?  

28) Have you and your family discussed the pros and cons of owning a Jack Russell Terrier?  YES    NO

29)  Is everyone in your family enthusiastic about getting a Jack Russell Terrier?   YES    NO

30)  Do friends, relatives and children have access to your home, property and car without your supervision?  YES    NO

31)  Are you willing to instruct your children and other people that visit your home frequently on the proper handling and care of Jack Russell Terrier?  YES    NO

32)  Have you considered the long commitment of time and financial resources required for dog ownership?  YES    NO

33)  Is there a veterinarian that you use now or have used in the past?   YES     NO

34)  If you do not have  a veterinarian, would you like a rescue representative to recommend a veterinarian in your area that is knowledgeable about Jack Russell's?   YES    NO

36)  Would you consider volunteering for our organization?  YES    NO

If YES, in which of the following areas:  (Check all that apply)