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Military Application Form

Which dog are you interested in?

Of all the breeds you could have chosen from, why did you choose a pit bull?


What drew you to this particular dog?


About You



Name


Home Phone
Cell Phone
Address
City/State/Zip
County
Please note: we do not have the resources to adopt outside of San Diego County at this time.
If you are outside of our service area, we encourage you to help your own community by adopting locally.
Email

Driver's License #   Your Age

Occupation

Military Information



Rank/Rate


Present Duty Station
Present Command
Command Duty Phone Number

How long have you been at present duty station?


Did you have any animals at your last duty station?
Yes  No

If yes, are the animals with you at your present address?
Yes  No

If no, why not?


At present time, do you live
On base housing
Awaiting base housing
Off-base military housing

Home owner
Renting
 
If you rent, please provide us with contact information for your landlord.
We will contact your landlord as a condition of approval.


Contact Name  
Contact Phone Number  

If you are on Shore Duty at present time, what provisions will be made for the animal(s) once on sea duty or deployed (i.e. Spouse / Family members)


If on TAD/TDY (i.e. schools, detachments, etc) from present duty station, what provisions will be made for the animals?


When transferred, what will you do if no housing/renting is available in the local area for animals, or for Pit Bulls?


If you are a reservist and get activated, what provisions will be made for the animals?

What is your EAS?

References

Employer
Work Phone
Address
City/State/Zip:


Personal Reference:

Phone


Vet:

Phone
Address:
City/State/Zip

Your Family

How many total people reside in your household?  

Ages of the people in your household (check all that apply)
0-2
3-5
6-13
14-18
19-30
30+


Do all members of the household want a pet?  Yes  No

Do any family members have asthma or allergies?   Yes   No

Do you currently own or have you owned a pet before?  Yes  No

If yes, how long did you have your pet?  

If no longer with you, what happened to him/her?


What other pets live with you? (please give numbers, ages, breeds and sexes)


Are they all spayed/neutered?  Yes  No

If any of them are not spayed/neutered, would you consider that as a condition of adoption?  Yes  No

Your Home

Do you rent or own your home?  Rent  Own

If you rent, please provide us with contact information for your landlord.


IMPORTANT: Many homeowner's insurance companies have breed blacklists which include, but are not limited to, pit bulls, American Pit Bull Terriers, American Staffordshire Terriers, Staffordshire Bull Terriers, Rottweilers, Dobermans, Akitas, American Bulldogs, Chows and wolf-hybrids and will not insure you if they reside in your home or may cancel your insurance if you add a dog of these breeds to your home. Please check your homeowner's insurance policy regarding breed discrimination before submitting this application to adopt a pit bull type dog. Landlords may also have these same breed restrictions due to their insurance policies. Please check this out before applying to adopt one of these breeds.

Do you have a yard?  Yes  No

Is the yard fenced?  Yes  No  N/A

  If yes, what type of fence?   

  If yes, approximately, how high is the fence at the lowest point?  

sDo you have a pool?  Yes  No

  If yes, is there a fence around the Pool?  Yes  No  N/A

Your Lifestyle

Why are you considering adding a pet to your life? (Check all that apply)
Companion for Children
Working Dog
Protection for Home/Family
Companion for other pets
Companion for Adults only
Other:


Will you be giving this dog as a gift?  Yes  No

Where is your pet going to be when you are home? (Check all that apply)
Dog will be a house pet, living inside with the family
Dog will live in the basement or garage primarily
Dog will live outdoors primarily
Dog will live in a fenced dog run with a dog house
Dog will have a job as a guard dog for:
Business    Residence
Other:

On average, how many hours per day will your pet be left alone?

When home alone dog will be (check all that apply):
In a crate, wire cate or dog pen inside
In an enclosed kennel outside
Tied up outside: On a cable run   With a chain
Dog will be loose indoors
Dog will be loose outdoors
Other:

How do you plan on keeping your pet exercised? (check all that apply)
Leash walks every day
Will 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 run & play together off-leash)
Other:

Describe what kind of training you will provide for your pet.


What behaviors would you consider unacceptable in a pet?


If your pet exhibited these behaviors, how would you respond?
Return the dog to Pit Bull Rescue San Diego
Bring the dog to a shelter
Seek training from a professional trainer or resource
Change the dog from an inside pet to an outside dog
Give the dog to a different family who can tolerate those behaviors
Consider the behavior an isolated incident and hope it doesn't happen again
Punish the dog.
Please elaborate on type of punishment:

There are a lot of true and false statements made about Pit Bulls in the media. What are some truths that you know about the breed?

Is there any other information you feel we should know about you?


Liability Release

Pets are an investment of your time and money. Are you prepared to provide medical care, grooming, proper diet, proper shelter and exercise for your new pet?
Yes  No

Do you understand that if arrangements don't work out with your new pet, you must be willing to return it to Pit Bull Rescue San Diego?
Yes  No

Please note that when PitBull Rescue San Diego rescues a dog, they rescue that dog for life. If we ever find that you have knowingly neglected any of the basic necessities for your dog as defined by California Law, we have the right to request that you return the dog to our care.

By checking YES you agree to absolve PBRSD and all of its representatives from any liability in reference to a dog featured in this web site.
Yes  No

By checking YES you agree that the dog will not be used in any illegal activities nor be found at any time in a municipality where Pit Bull presence is illegal.
Yes  No

By checking YES you agree that the dog is to be kept as a house pet. It shall not be sold for medical or experimental purpose, and it shall not be used for breeding.
Yes  No

Thank you for choosing rescue as a means towards adding a new family member to your life. We will review your application and respond to you within 48 hours.