First Name*
Last Name*
Address
City
State/Province
Zip/Postal Code -
Email*
Home Phone
Cell Phone
Alt Email
Is there a certain Dog you are interested in, if so, which one? Choose an animal: Butterscotch Crosby Dalton Dixie Dusty Dusty Jack Mickey Neila Niko Pebbles Petey Reed Remi Romeo Sinatra Wilbur
Veterinarian's Name, Address and Phone Number*
Will the animal be kept inside or outside* Choose one: Inside Only Outside Only Inside and Outside
Where will the animal be kept when you are not home*
Do you currently have any other pets?
If yes, please describe the pets in detail: Name, Age, How long in your home, Full description including sex *
If 'yes' are they currently on heartworm preventative?* Choose one: Yes No
Do you own or rent your home?* Choose one: Rent Own
If you rent, please enter your landlord's name and phone number*
Who will be responsible for the caring for your dog if something should happen to you?*
I certify that the above information is true and I understand that prior to being approved for adoption, the above information will be verified. I also agree to a personal interview with a member of ARRF, if required, to determine the suitability of my home/facility to care for a canine. I also understand that if at any time ARRF feels the dog is not being cared for properly, or feel the dog is being abused; ARRF will take back possession of the dog. In the event that you can no longer keep the dog, ARRF must be notified immediately. I understand and agree that falsification of any of the above information is grounds to disqualify my adoption application and nullify all adoption(s) and/or adoption agreements between the applicant and ARRF. I understand my electronic signature is legal and binding. I authorize ARRF to attain any information needed from all above references. Please sign here*
