Please answer all of the following questions as completely as possible. The more details you give us, the easier it will be to match you up with the right Rottie. As soon as we receive your completed form one of our volunteers will contact you to discuss your application and arrange for a home visit. Then you, your family and other dogs, will be invited up to meet our dogs. Our goal is create a lifelong relationship for you and your new Rottweiler. Thank you for helping us save these wonderfule Rotties.
All of our adoptions require a $200 donation to help supplement the cost of medical treatment, food and associated cost. We are sorry but if we did not charge we couldn’t save these dogs. Most dogs we spend more then we get back but every little bit helps us in our cause to save this wonderful breed. Thank you for your understanding and remember that your donation may be tax deductable.

Please fill out application as fully as possible and then click submit. Someone will follow up with you shortly.

Name:

Spouse Name:

Address:

City:    State:    Zip:

Employer:

Spouse Employer:

Email Address:

Home Phone:      Ext:

Are either of you a student? Yes No

If yes date of graduation

Are either of you in the Military? Yes No
If yes date of Discharge?


Family Information

Please list children at home and thier ages


If there are other adults in the home please list them and their relationship to you



Is anyone in the home allergic to animals? Yes No

Does anyone have asthma? Yes No


Home Information

How long have you lived at your current Address?

If less then 2 years please provide previous address


Please describe your neighborhood: City Suburb Country/ rural

What type of home? Apartment Duplex House Mobile home

Do you Own Rent ?

Does your home have a yard? Yes No

If Yes, please describe your restraint system:

If fenced, what type of fence & how tall?

Can strangers gain access to your yard from the street? Yes No

Other Pet Information

Do you have other pets at this time? Yes No

If yes:
Are they spayed or neutered yet? Yes No

Are they currently on heartworm preventative? Yes No

Are they indoor or outdoor? Indoor Outdoor Both

Please describe your current pets and their gender


If you have owned pets in the past, what happend to them?

Placement Information

Have you ever owned a Rottweiler before? Yes No

What type of dog are you looking for? Indoor Outdoor Both

What role would you like your new Rottweiler to have? check all that apply
       Companion/pet Protection Therapy Hunting
       Other roles (specify)   

Please describe where the dog will stay when you are at home:


Please describe where the dog will stay when you are away:


How many hours per day will the dog be alone?

Do you have a crate? Yes No

If yes how many hours a day will the dog be crated?

Do you plan to use a crate? why or why not?


Do you currently have a dog door? Yes No
If no would you consider putting one in? Yes No

What kinds of solutions would you do if housebreaking accidents occured?
Crate Dog door leave outside Would return the dog
Other solutions (specify)

Are you familiar with the signs of gastric torsion (bloat)? Yes No

Are you aware that Rotts can be more prone to Parvo virus? Yes No

References

Please provide us with your current veterinarian contact information:


If less than 5 year please provide previous vet contact information:


Please provide three references that are not related to you:

Reference #1 Name, day and evening phone


Reference #2 Name, day and evening phone


Reference #3 Name, day and evening phone


And Finally

Do you have a gender preference? Male Female Either

Age preference?

Which dog are you interested in?

How did you hear about us?

If there is any additional information you would like to add, please type it below: