Name *

First Name

Last Name

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Have you ever applied for a dog from BARRK before?

Yes

No

Have you applied to adopt a dog from any other rescues?

Yes

No

Employer Phone Number

(###)

###

####

Has this been discussed with all members of the home?

Yes

No

Do you rent or own?

Rent

Own

Is the yard fenced?

Yes

No

May we visit your home?

Yes

No

Have you had animal in the last 10 years?

Yes

N0

Have you ever given away, surrendered, or sold a pet before?

Yes

No

Are you aware and do you accept that BARRK requires that all dogs and cats in the household be spayed/neutered before an adoption of a BARRK dog can take place? *

Yes

No

Are you aware and do you accept that BARRK requires an adoption fee? *

Yes

No

The average dog has a lifespan of 12 to 15 years. Are you willing to make a commitment to this dog for the rest of his/her life?

Yes

No

If this is a long distance adoption, are you willing to:
 *

Travel to get the dog (by plane or car or both?)

Pay for the costs of transportation

Meet somewhere along the way

Unable/Unwilling to travel or assume costs

If, for any reason, you are unable to keep your dog, do you agree to notify BARRK immediately? *

Yes

No

If you are unable to keep your dog, do you agree to return him/her to BARRK without hesitation? *

Yes

No

If this is a long distance adoption, and you are unable to keep your dog, are you willing to assume the responsibility, including travel and financial responsibility, for returning the dog to BARRK? *

Yes

No

I agree to the following: All statements made on this application are truthful; I have made no false statement with regard to family members in household, references provided not being family members, status of my home ownership and any other statements made on this application. *

I agree

I disagree

I certify that all information provided on this form is true. I give permission to Rescuer to verify information as needed. I understand that a home check may be mandatory prior to adopting a pet, also.  Any false statement will terminate potential adoption. Furthermore, I understand and accept that the adoption decision depends upon many factors, including – but not limited to – the compatibility of the family and home to the individual dog and other applications received on the dog. I understand and accept that BARRK. will decide which home is most appropriate for the individual dog, and therefore I will not take issue with the decision. Unless otherwise indicated by BARRK, I may be considered for another dog.
 *

Agree

Disagree