ADOPTION APPLICATION FORM Submitting this form does not constitute an agreement or guarantee of adoption from Jack Russell Terrier Rescue Ontario. It is merely the initial step in the adoption process and will help us decide if you are a right fit for adoption. A representative from the rescue will contact you if you have supplied sufficient contact information. Jack Russell Terrier Rescue Ontario has the right to refuse any application. An adoption fee of $200.00 for dogs and $300.00 for puppies is required at the time of adoption to help cover vet bills, spay/neuters or any other medical attention needed prior to placing. If you don't feel comfortable filling out our application and have any specific questions about our adoption process, our available dogs or our application, please feel free to contact us at adoptions@russellrescue.org with your name, phone number and the best time to contact you and we would do our best to get back to you within 48hrs. All information will be kept strictly confidential and will be used solely for contact information and to determine suitability of the applicant in adopting a JRT. Owner Information *Name *Home Phone *Address *City *Postal Code Email Occupation *Best time to call? Residence Information *Do you own or rent your home? Own Rent If rent, do you have your landlord's persmission to keep a dog? Yes No Name of Landlord Landlord Phone *Do you live in a: House Apartment Trailer Other How long have you lived at this address? Terrier Containment *Do you have a completely fenced in yard? Yes No Do you have a kennel run? Yes No Describe kennel run type, height and size If no fence or kennel, how will you handle terrier's exercise and toilet needs? *Do you have a suitable dog crate? Yes No Household Environment *How many adults in home? *How many children in home? Ages of adults If children, list ages Are any members of your household allergic to animals? Yes No *How many hours a day will the terrier be alone? Are there other visitors to your home, human or animal, with which a new dog will have to interact? *How would you describe your lifestyle? Active Passive *Other Animals *Do you own other dogs? Yes No Spayed/neutered? Yes No If yes, list breed, size and gender of each *Do you own cats? Yes No If yes, how many? *Do you own other animals? Yes No If yes, describe How many and types of dogs have you owned in the past five years? If you do not still own the dog(s), please describe what happened to it (them). Please be specific. Planning *When can you take the dog? *How far are you willing to travel? *Planning on having children in the next 5 years? Yes No *Have you owned a Jack Russell Terrier before? Yes No *Why did you choose this breed? *What activities do you plan with this dog? Pet Guard Hunting Obedience Agility Trials *Do you intend to keep this dog primarily: Indoors Outdoors *Where will the dog sleep? *Do you have a regular veterinarian? Yes No If yes, Name Phone Address? Preference *Do you want to adopt a: Male Female No Preference Age Preference *I would be willing to consider a suitable dog of a different Age Sex Are you interested in a particular dog we have available? Personal References 1. Name Relationship Phone 2. Name Relationship Phone Other comments *How did you learn of the JRTCC Russell Rescue? Would you be able to help foster or transport for JRTRO? Foster Transport
Jack Russell Terrier Rescue Ontario (JRTRO) Copyright 2003-2008. All Rights Reserved.
Last Updated: August 14, 2009