Adoption/Rescue Application

Completing this application with as much information about your household helps the Rescue staff use the information to determine the best placement for the dog.

Applicant
Last Name   First Name   Age

List names, relationships and ages of other people living in household:
 Name Relationship Age
 Name Relationship Age
 Name Relationship Age
 Name Relationship Age
 Name Relationship Age

List species of animals currently living in your home:  Example: Dog/Shepherd-mix
 Species/Breed if known Gender MaleFemale Spayed/Neutered YesNo Age
 Species/Breed if known Gender MaleFemale Spayed/Neutered YesNo Age
 Species/Breed if known Gender MaleFemale Spayed/Neutered YesNo Age
 Species/Breed if known Gender MaleFemale Spayed/Neutered YesNo Age
 Species/Breed if known Gender MaleFemale Spayed/Neutered YesNo Age

Physical Address City State Zip Code

Daytime Phone Number Evening Phone Number   Email Address

Enter Mailing Address if different than Physical Address

Indicate if this is a: Single Family Home Apartment/Condo Townhome Duplex Ranch Other

Do you: Own Rent
If you marked "Rent," are you able to provide proof that your landlord will allow a large pet to live in your home? Yes No

Do you have a fenced yard? Yes No
        Type of fenced enclosure: Block Chain Link Board Wrought Iron Other
        Height of fenced enclosure:

Do you have a locked gate? Yes No
        Is the gate locked all the time? Yes No

Will you allow rescue volunteer to assess your home prior to your adoption? Yes No

How many hours per day will your pet be left alone:

Where will your pet stay during the day: Inside/Outside access Inside Crate Outside with dog shelter

Where will your pet stay during the night: Inside/Outside access Inside Crate Outside with dog shelter

Are you willing to consider using a professional behaviorist/trainer if needed or recommended? Yes No

Have you utilized the services of a professional trainer in the past? Yes No

May we contact your trainer? Yes No

If "Yes", Please provide the name and contact information:

Name Address

City State Zip Code Phone Number

Email Address

Would you be using this trainer again? Yes No

What types/forms of training are you familiar with:

Please describe any previous training challenges you have faced and how you resolved the challenges:

If you have young children or grandchildren in the house, please describe their experience in handling a pet, including whether they have received or will receive formal training:

If you do not currently have children/grandchildren, do you foresee the possibility of children/grandchildren in the near future? Yes No
If "Yes", please describe your plans for integrating your pet and child:

Do you currently have or use a veterinarian? Yes No

May we contact your veterinarian? Yes No

If "Yes", Please provide the name and contact information:

Name Address

City State Zip Code Phone Number

Bouviers do shed and require frequent brushing of their coat to keep it matt free; professional grooming can be costly.

Are you aware of the cost of professional grooming? Yes No

Are you willing to take lessons in grooming your Bouvier? Yes No

If "No", do you currently have a professional groomer available? Yes No

May we contact your groomer? Yes No

If "Yes", Please provide the name and contact information:

Name Address

City State Zip Code Phone Number

If you do not have a groomer currently in place, what are your plans for caring for the grooming needs of your rescue Bouvier?

Applicant Employment

Occupation   Employer   Phone OK to call

Address City State Zip Code

Years Employed   Hours per day at work (include commute)

Work Days:  Sunday Monday Tuesday Wednesday Thursday Friday Saturday Varies

Does your job require travel? Yes No

If "Yes", please describe what accommodations you will make for the dog in your absence?

Spouse Employment

Occupation   Employer   Phone OK to call

Address City State Zip Code

Years Employed   Hours per day at work (include commute)

Work Days:  Sunday Monday Tuesday Wednesday Thursday Friday Saturday Varies

Does your job require travel? Yes No

If "Yes", please describe what accommodations you will make for the dog in your absence?

What other breeds did you consider adopting before you decided to adopt a Bouvier?

What about the Bouvier makes you want to own one?

What hands on experience(s) have you had with a Bouvier?

Gender preferred: Male Female Doesn't Matter              Age preferred: Puppy 2-5 years old Over 5 years old

Your dog will be used for: companion for another dog family companion commercial guard dog guard dog
Agility/Carting/Herding/Obedience pet therapy

If you have utilized the services of a breeder in the past, please provide their name and contact information:

Name Address

City State Zip Code Phone Number

Who in your family wanted to get a Bouvier?

Please provide information on the number of dogs you have had in your adult life:

There is no such thing as a hypo-allergenic dog. Some dogs do have hair while other has fur. Dogs with hair tend to shed less but all dogs shed and all dogs require grooming including Bouviers.

Is any member of your household allergic to dogs or suffer from asthma? Yes No

If "Yes", what have you done to allow you to work around your allergies/asthma and allow you to own an indoor pet?

Have you read "Don't Buy a Bouvier" by Pam Green? Yes No

If for any reason you find that the dog you adopt from us can no longer be kept by you, it is agreed by contract that the dog would be returned to Rescue.

Our Rescue Program is not without cost. Each adopter is asked to make a donation at the time the adoption contract is made. Donation minimum is determined on a sliding scale. Completing and submitting this application does not guarantee you a re-homed Bouvier from SCBdFC. The dogs are placed in a home where they will be the most successful. Our goal is the best to match a dog's temperament and needs with the expectations and lifestyle of a family. We all work together and we keep in touch to make sure everything is going well and everyone is happy.

The Rescue Staff