Adoption Form – Northern Bound Rescue

Email : northernbound@live.com

Northern Bound Rescue Adoption Application

Name of Puppy You're Interested in (Required)

Your First Name (Required)

Your Last Name (Required)

Street Address (Required)

City (Required)

State (Required)

Zip Code (Required)

Your Email (Required)

Occupation (Required)

Hours Worked (Per Week) (Required)

Names and Ages of All Other Household Members

Home Phone (Required)

Cell Phone

Work Phone

Does Everyone in the Household Agree to Adopting a Puppy? (Required)

How Long Have You Lived at Your Current Residence? (Required)

Do You Rent or Own Your Residence? (Required)

If You Rent, Please Enter your Landlord's Name and Phone Number (Required)

Why Are You Interested in Adopting From Northern Bound Rescue? (Required)

If Any, Please List All Other Pets in the Household, and confirm if they are spayed/neutered.

Current Veterinary Name, Address and Phone Number. (If None, Please Type N/A). (Required)

Do You Live on a Busy Street or Road? (Required)

Do You Have a Fenced Yard? (Required)

If Yes, What is the Style and Dimensions?

Does Anyone in the House Have Allergies? (Required)

May we Visit Your Home Prior to Approval? (Required)

On a Typical Day, How Long Will the Dog Be Left Alone? (required)

Where Will the Dog be Left While Home Alone? (Required)

Do You Have Experience in House training? (Required)

What Type of Exercise Will You Provide for Your Dog and How Much? (Required)

Please Provide Us With Two Personal References; Name, Address and Phone Number. (Required)

Part Two - Please Provide Answers to the Following Questions and Situations.

Your Potential Rescue Dog May Have Come From an Abusive Setting and Been Neglected for
Some of Their Lives. This May Have Led to Poor Socialization, Nervousness, Aggressiveness and
an Untrusting Feeling Towards People. Do You Understand That it May Take Time to Build a
Trusting Relationship Between You and the Dog? They May Need Special Attention to Try and Fix
the Damage Done to Them. (Required)

You Understand That if Chosen to Adopt from NBR, it MUST be an Inside Dog and WILL NOT be Tied Up Outside to a Tree, Fence, etc..or Left in an Outside Kennel. (These Dogs are From the South and Most Have Never Experienced the Cold Weather We Have in the North). (Required)

You Have Budgeted Enough Money to Take Care of Your New Dog, Including Food, Annual Vaccinations, Toys, Treats, Crates, Bedding and Emergency Vet Bills? (Required)

Do You Agree to Allow a Member of Northern Bound Rescue to Visit Your Home by Appointment Before the Adoption is Final? (Required)

Do You Agree That If Things Do Not Work Out With This Dog in Your Home, it Will be Returned to Northern Bound Rescue and to No One Else with NO REFUND of the Adoption Fee? (Required)

Do You Understand That House training May Take Some Time and That the Dog May Have Many Accidents? (Required)

Do You Agree That You Will Follow All Local and State Laws Regarding the Registration of Your Dog? (Required)

Where Will the Dog Stay if You Leave For an Extended Period of Time? (Required)

Under What Circumstances Might You Decide NOT to Keep This Dog? (Required)

Please Tell Us Why You Want a Dog. (Required)

Please Tell Us a Little About Your Family and Lifestyle. (Required)

Is There Anything Else You Would Like Us to Know About Your Family or Application? (Required)

Who Will Care For, Train and Exercise the Dog? (Required)

Please Enter Your Full Legal Name to Agree With the Statement Below. (Required)

Signature (Required)

By submitting the Adoption Application, I declare that the information I have provided is true and accurate. I understand that submission does not guarantee adoption of a dog from Northern Bound Rescue. I will allow Northern Bound Rescue to contact my landlord, veterinarian and personal references at any time NBR sees fit.