| Applicant First Name: |
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| Last Name: |
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| Your Age: |
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| Co-Applicant First Name: |
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| Last Name: |
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| Co-Applicant Age: |
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| Residential Address (Not a P.O. Box): |
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| Address 2: |
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| City: |
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| State: |
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| Zip Code: |
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| Home Phone: * |
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| Cell Phone: * |
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| Best Time of Day to Contact you?: * |
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| Email: * |
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| Years at Residence: |
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| Distance willing to travel to adopt: |
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| What large city is nearest to your home?: |
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Expectations of a Rescued Bulldog |
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| Number of residents in the household: |
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What age Bulldog are you willing to adopt:
Please Note: We do not often get puppies in rescue. |
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| Must the Bulldog be good with children? |
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| Are you willing to adopt a special needs Bulldog?: |
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| Must the Bulldog get along with other dogs in your household and/or with visiting dogs?: |
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| If Yes or Possibly, what level of special needs would you accept?: |
MINIMAL (Daily medications, special food, etc.)
MODERATE (Frequent medications, house training issues, difficulty walking, behavior issues, etc.)
SEVERE (Blindness, deafness, incontinence, seizure disorder, etc.)
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Employment Information - Applicant |
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| Occupation: |
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| Employer Name: |
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| Work Address: |
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| City: |
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| State: |
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| Zip Code: |
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| Work Phone: |
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| Occupation: |
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| Employer Name: |
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| Work Address: |
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| City: |
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| State: |
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| Zip Code: |
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| Household Members other than Applicant(s) |
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| Name, Age, Relationship: |
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| Name, Age, Relationship: |
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| Name, Age, Relationship: |
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| Name, Age, Relationship: |
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| Name, Age, Relationship: |
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| Do children visit in your home?: |
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| If yes, ages and frequency: |
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| Are you willing to supervise the Bulldog at all times with children under the age of 10?: |
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| Is anyone in the household allergic to dogs?: |
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| Who will be responsible for caring for the Bulldog?: |
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| Are all household members in favor of adopting a Bulldog?: |
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| Annual Family Income: * |
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Dwelling Information |
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| Type (e.g., House, Apartment, Condo, Mobile Home) |
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| Rent or Own?: |
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| If rent, Landlord Name: |
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| Phone: |
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Note: If you rent, the landlord contact information is reqiured. We must contact your landlord to verify that you are allowed to have pets. |
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| Do you have a fully enclosed fenced yard?: |
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| If yes, type: |
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| Height: |
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| How will the dog be exercised, how often, and who will supervise the dog while outdoors?: |
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| Does your home have stairs that the Bulldog will have to go up and down?: |
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| If yes, describe: |
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| Do you have a swimming pool, pond (including ornamental ponds), in-ground hot tub, lake, river, or any body of water in or near your residence?: |
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| If yes, is there a secure fence to keep the bulldog out?: |
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| Is your home air-conditioned?: |
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| If yes, type (central or room): |
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| Is your car air-conditioned?: |
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Lifestyle
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| What five words best describe your family?: |
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| Please describe any changes you expect in your household in the next few years; e.g. new children, job changes, moving, etc.: |
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| How soon will you be ready to adopt a Bulldog (Please check applicable): |
Immediately
Next 3 Months
Next 6 Months
More than 6 months
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Are any family members at home during the day time (Please check applicable):
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All Day
Most of the Day
Sometimes
Seldom |
| Are you involved in any pet store, commercial dog breeding operation, or buying dogs for resale?: |
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| Have you ever been convicted of cruelty to animals?: |
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| Have you ever been suspended from a pure-bred dog association?: |
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| Have you applied to adopt with any other Rescues?: |
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| If yes, which ones?: |
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| Pets (Current and Past ) |
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| Have you ever owned a Bulldog?: |
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| Do you currently own any dogs?: |
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| Do you currently own any cats?: |
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| Please list all pets (dogs, cats and others) owned now or in the past 5 years.: |
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| Type/Breed: |
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| Age: |
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| Gender: |
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| Spayed/ Neutered?: |
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| Where are they now?: |
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| Have you ever given a pet to a rescue organization or animal shelter?: |
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| If Yes describe the circumstances: |
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| Have you ever had a dog that has bitten someone?: |
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| If Yes, explain: |
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| Do all your current pets get along well with other animals?: |
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| If no, explain: |
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| Do all your pets receive regular veterinary care and are they up-to-date on vaccinations?: |
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| What heartworm preventative do you use?: |
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| If you have adopted a rescue before, provide details: |
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| Your veterinarians name: * |
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| Address: |
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| City, State, Zip Code: |
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| Your veterinarians phone #: * |
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| Pet Care Philosophy: |
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| Are you willing to work with the rescued Bulldog to resolve problem behaviors? (e.g., chewing, pulling on lead, barking): |
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| What type of behavior in a dog would make you not want to adopt him or her?: |
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| How will you correct behavior problems?: |
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| Do you understand that rescued Bulldogs may have house-training problems, especially at first?: |
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| Are you familiar with common Bulldog health problems?: |
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| How much do you expect to pay per year to take care of a Bulldog?: |
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| Who will care for the Bulldog during vacations or overnight trips?: |
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| Can someone in the household provide daily care when the primary caregiver is away?: |
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| Do you have an emergency plan to provide care for your pets if you have to leave town suddenly?: |
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| If Yes, please describe: |
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| What do you feel is the proper use of crates or cages?: |
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Agreements/Understandings:
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| Can all household members travel to the rescue group to meet the prospective adoptee?: |
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| Are you willing to take responsibility for the Bulldog for its lifetime?: |
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| Do you agree to having a rescue volunteer inspect your home before and/or after an adoption is completed?: |
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| All Bulldogs adopted from us will be spayed/neutered before placement. Do you have questions or reservations about this policy?: |
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| If Yes, explain: |
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| References |
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| List name and telephone number of two people, not in your household, who can verify your ability to take good care of a rescued Bulldog: |
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| Additional Comments: |
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| I understand that the adoption fee is non-refundable. |
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| I understand that Illinois English Bulldog Rescue has the right to refuse any placement with a potential adoptive home. |
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| I understand that dogs placed by the BCA Rescue Network have been acquired, fed and boarded; have received necessary medical care and vaccinations; and have been tested to be free of heartworms and contagious disease at the expense of BCA Rescue Network volunteers, who receive financial reimbursement for expenses only through donations. I understand that I may be asked to give a donation to the BCA Rescue Network to help with the spaying/neutering and veterinary care of current and/or future rescued Bulldogs.: |
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| Signature: |
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| Date: |
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| PLEASE BE SURE TO NOTIFY US IMMEDIATELY SHOULD YOUR SITUATION CHANGE OR YOU ADOPT ELSEWHERE. |
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