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Name:
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Address:
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City:
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State & Zip:
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Home Telephone Number:
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Work Telephone Number:
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Email Address:
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Best Time To Call:
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Do You:
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Own My Home
Rent My Home
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If You Rent, Your Landlord's Name and Telephone Number:
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If Your Renting, For How Long At This Location?
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If You Rent, Has Your Landlord Cleared A Pit Bull There?
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Yes
No
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Do You Live In A:
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Manufactured Home/Trailer
House
Condo
Apartment
Other
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You Would Like To?
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Adopt
Foster
Foster To Adopt
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How Much Experience Do You Have With Pit Bulls?
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None
Little
Some
More Than Most
Experienced
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When A Dog Does Something Wrong, What's Your Idea Of, Or Do You Believe In A Punishment?
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Have You Ever Had Issues/Problems With Animal Control/ASPCA/USHS Before?
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Yes
No
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If Yes Please Explain:
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Do You Have A Well Fenced Yard?
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Yes
No
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Approximate Size, and Fence Height.
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Does the Fencing Completely Enclose The Yard?
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Yes
No
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If Not, Are You Willing To Fence The Yard?
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Yes
No
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Number of Adults In Household.
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Number of Children.
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Do You Have Other Companion Dogs?
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Yes
No
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If Yes, How Many, Breed, Gender and Age.
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Are They Spayed and/or Neutered?
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Yes
No
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Are They All Tagged And Current On Rabies?
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Yes
No
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If yes, names and county licensed at. (This is to make sure they are current, we will call to check)
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Do You Have Cats In Your Home?
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Yes
No
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If Yes, How Many?
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1
2
3 or more
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Do You Own Any Other Animals?
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Yes
No
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If Yes, How Many?
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Have You Owned A Companion Dog Within The Last 5 Years?
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Yes
No
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If Yes, Do You Sill Own These Companion Dogs?
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Yes
No
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If Not, What Happened To These Dogs?
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Do You Have a Breed, Size, and/or Gender Preference? If Yes, Please Describe.
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Please Describe How You Plan On Spending Time With Your Adopted/Foster Dog.
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Where will your Adopted/Foster dog spend the day?
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On Average, How Long Will Your Adopt/Foster Dog Spend Alone?
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Where Will Your Adopted/Foster Dog Spend The Night?
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Does All The Family members want to adopt/foster a dog?
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Yes
No
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Are any family members allergic to dogs?
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Yes
No
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If Yes, How bad, and what is their reaction?
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Do you agree to contact this or one of it's cooperating agencies if you no longer can take care of or can not keep your adopted/foster dog?
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Yes
No
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Are You Willing to let one of this or cooperating organizations representatives visit your home by appointment?
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Yes
No
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If No, Please explain:
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Do you have a current, or have you had a past vet?
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Yes
No
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If Yes, May We Contact Them?
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Yes
No
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If Yes, Information below please, if No, please explain.
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Are there any person(s) You would like us to contact who can confirm the care you provide for your companion/adopt/foster animals?
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Date of Application
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Please feel free to leave any additional information you feel we need to know here.
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