Adoption Application

● Name of animal you are interested in: _________________________________

● First & Last Name: _________________________________________________
● Are you over 25: ________________________________________________________
● Email address: __________________________________________________________
● Address, City, State, Zip: __________________________________________________
● Phone Number (including area code): ________________________________________
● Are you employed? (Please specify): _________________________________________
● Type of Residence (Please specify): __________________________________________
● Do you Own or Rent: _____________________________________________________
● If you Rent, does your landlord allow pets: ____________________________________
● Landlords Name & Number: ________________________________________________
● Do you plan to move in the near future? ______________________________________
● Are other family members aware that plan to Adopt a pet? ______________________
● Reason for Adoption: ______________________________________________________
● How many adul ts live in the household? _____________________________________
● Full names of all adults: ____________________________________________________
● How many children live in the household? _____________________________________
● Age of child/children: _____________________________________________________
● Do you have pets now? ___________________________________________________
● What kind of pets? _______________________________________________________
● How many of each kind? __________________________________________________
● If you have pets, how many are spayed/neutered? _____________________________
● How many are up to date on shots? _________________________________________
● What kind of pets have you had in the past? __________________________________
● What happened to your last pet? ___________________________________________
● Have you ever had to give up a pet? If YES, Please explain: _______________________
● Is anyone in the house allergic to animals? ____________________________________
● Do you have a present vet? If YES, vets name & Number? ________________________
● Will your pet live Inside or Outside? _________________________________________
● If inside, how do you plan to train? _________________________________________
● If outside, how do you plan to confine? ______________________________________
● Do you have a fenced yard? ________________________________________________
● Are you aware of and prepared to meet the first year’s cost of regular preventive
veterinary care ( approximately $100 - $200), food, and supplies ($100-$150):________
● Do you feel willing and able to work with your dog to correct problem behavior if it
should develop (Barking, destructive clawing, jumping, or digging)?________________
 ● What are your ideas for dealing with such behavior? Please note that not all problem
behavior can be corrected. Most behavior can be corrected with patience,
perseverance, and/or expert help: _________________________________________
● Do you have any poisonous or toxic plants like ivy, philodendron, or poinsettia? _____
● If you have poisonous or toxic plants, would you be willing to place them out of reach
or remove them from your home?____________________________________________
● Who will be responsible for your new dog’s care? ______________________________
● How many hours of a day will your dog be alone? ______________________________
● How many days of the week will your dog be alone? ____________________________
● Where will your dog be kept when they are alone? _____________________________
● Your dog will be micro-chipped for permanent identification. Do you agree to register
your dog with the 24 hour Pet Watch database (this is FREE and will not cost you for
the first year)? __________________________________________________________
● If you move, will you update this information with 24 Pet Watch and Unbreakabull
Bullies? ________________________________________________________________
● Note: Since your dog will be wearing a collar, please be sure to use a safe dog type
collar. These collars easily break off or expand to slip over the head if your dog is
caught on something. Do not use a pinch or choke chain. Unbreakabull Bullies, and
Iowa Law require that adopted animals be altered (spayed/neutered). Do you agree
with this policy? ________________________________________________________
● Are you prepared to give your dog plenty of time to adjust to its new home? We
encourage the 2 day, 2 week timeframe. It will take your dog approximately 2 day to
become familiar with the new home and 2 weeks to become comfortable with the
family and other pets. Will you give your new dog this time?______________________
● Would you consider Adopting 2 dogs for companionship, especially if there is often no
one at home? ____________________________________________________________
●
I certify that the information I have given is true. I authorize the investigation of
all statements in this form. I understand that Unbreakabull Bullies has the right
to refuse any request for adoption.

Online signature: _______________________________________________________________