[ Pit Bull / "Bully Breed" Adoption Application ]

4400 Raytown Road, KCMO, 64129
Phone: (816) 921-0201
email@petshalfwayhome.com

All application for Pit Bull dogs and Bully Breeds are screened by Missouri Pit Bull Rescue.
This application will allow MPR to determine if a pet you are interested in adopting would be a good match for your family. The application does not guarantee an adoption. It is only a good starting point to begin communication between a potential adopter and an Adoption Counselor. The application will allow the Counselor to answer specific questions or concerns you might have and to evaluate your candidature for adoption.

We recommend that anyone interested in adopting a Pit Bull type dog, read MPR's Breed-Info.

Be aware that a visit to the shelter is required. Pets are adopted to the first qualified home.

Fields that appear with an asterisk * are required.

* Name of pet I am interested in:

* Second choice:

Personal Information:

* Last Name

* First Name

* Street Address

* City

* State

* Postal Code

* Primary Phone Number

Alternate Phone Number

* Email Address

* Occupation

* Your Age Range

* Would you welcome a pet adoption representative for a home visit prior to adoption?

Yes

No

Unsure

* REFERENCES: Please supply the name, title, and phone number of your current or previous
veterinarian. If you cannot provide that information, please provide the name a person not related
to you who can attest to your character. Veterinary references are preferred.

0/500 words

Liability and Responsibility

* Have you ever been convicted of a felony?

Yes

No

If so, please explain:

* By checking YES you agree to absolve the adoption representative
from any liability in reference to a pet adopted from this listing.

Yes

No

About Your Selection:

* Check all that apply:

I would like to give a pet a permanent home.

Interested in fostering only.

Open to foster with option to adopt.

Unsure - Have questions.

Interested in adopting two pets.

* I would prefer a:

Male

Female

Either one

* I would prefer a:

Puppy

Adult

Either one

* Why have you decided to add a new companion to your family? (check all that apply)

* Please explain why you would like to adopt a pit bull (or other "bully breed" if applicable):

* Do you have any previous experience with this breed? If so, please explain:

Do you have any requirements for a pet you would like to adopt? Please specify:

Your Family and Home Situation:

* I live in a:

* My home is located in:

An urban area

A suburban area

A rural area

* Do you own or rent?

Own

Rent

Friend or relative owns residence

* If you are renting, please provide name & phone number of homeowner or landlord:

* How long have you lived at your current address?

* Does your city of residence have breed-specific legislation?

No. I called Animal Control and verified.

Yes, and I meet restrictions - see below for specifics.

I don't know.

Breed Specific Legislation Restrictions:

If you own your home, does your homeowner's insurance have breed restrictions?

No. I called and verified.

Yes, and I meet restrictions - see below for specifics.

I don't know.

Homeowner's Insurance Breed Restrictions:

* I live: (check all that apply)

* Number of household residents:

* Number of children under 21 in household:

* Ages of individuals under 21:

* Are there any children in your environment? (check all that apply)

Pet(s) Living Situation

* Pet's living situation: (check all that apply)

Pet will be a house pet, living inside with family.

Pet will live in basement, garage, porch or sunroom.

Pet will live mostly outside, inside in bad weather.

Pet will live strictly outside with a doghouse.

Pet will live strictly outside with access to barn.

Other (specify):

* How many hours per day will pet be home alone?

* When home alone, pet will be: (check all that apply)

* When traveling: (check all that apply)

* How will pet be exercised? (check all that apply)

Leash walks every day.

Wil have cable or dog run in the yard.

Will be free to run in fenced yard.

Will have supervised access to unfenced yard.

Will be free to roam around off-leash and unsupervised in unfenced area.

Will bring to dog park (public area where dogs can run and play together)

Other (specify):

* Home yard size is:

Is yard enclosed by fence?

No fence

Fully fenced

Partially fenced

Plan to install or finish fence soon

Is there a doggy door?

Yes

No

If applicable, please describe fencing (height and type):

Other Pets

* Do you have other dogs? (check all that apply)

Please specify breed(s) and age(s) of other dogs:

What other kinds of pets do you own?

If you have other dogs or cats, please describe their living situation.
Are they inside or outside pets? Do they stay in crates, outdoor kennels,
or loose in or out of house when alone?

* If you have or had other pets, please let us know their current disposition:
(check all that apply)

Please explain what happened:

* In your opinion, what is a good reason to get rid of a pet?

Additional Information

Any additional information you would like to add:

* Indicates Response Required


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