Adoption Application

Applications will be automatically emailed to us when you SUBMIT it.
You must be 25 years or older to adopt.

Step 1 of 6

Dogs Information:

Dog(s) name you are interested in:*
Please select any of the following reasons you will be adopting this dog(s):*
Select One or More Reasons.

Step 2 of 6

Your Information:

Full Legal Name*
Date of Birth*
Email Address*
Phone Number*
Address*
Employer's Name
Employer's Phone Number
Employer's Address
Please select one or more from the dropdown.
If other, please specify:
Step 3 of 6

Housing:

Where do you currently reside / live?*
Do you Rent or Own?*
Does your landlord/lease allow pets?
Name of Landlord OR Complex Manager
Phone number of Landlord OR Complex Manager
Is there a limit to number of pets you may own?
What is the pet limit?
Is there a weight limit?*
How many times in the last 5 years have you moved?*
Do you plan to move in the next 6 months?*
Why are you moving?
Where are you moving? (City, State)
Does your municipality (State, City, HOA, etc.) have breed-specific restrictions?
Please specify restrictions:
Are you willing to have a Braveheart Bulliez Rescue Representative visit your home?*
Why not?
Will this pet be a surprise for anyone?*
Please explain surprise:
Are there any other adults (21 and older) living in the household?*
Adult 1 Name
Relationship
Age
Add Another
Remove
Adult 2 Name
Relationship
Age
Add Another
Remove
Adult 3 Name
Relationship
Age
Remove
Are there any children (under the age of 20) living in the home?
Child 1 Name
Relationship
Age
Add Another
Remove
Child 2 Name
Relationship
Age
Add Another
Remove
Child 3 Name
Relationship
Age
Add Another
Remove
Child 4 Name
Relationship
Age
Remove
Do you have any other pets in your current household?
Pet 1 Name
Type of Pet
Age
Breed
Gender
Are they spayed or neutered?
Why aren't they spayed or neutered?
Up-to-date on vaccinations?
Why aren't they up-to-date on vaccinations?
Add Another
Remove
Pet 2 Name
Type of Pet
Age
Breed
Gender
Are they spayed or neutered?
Why aren't they spayed or neutered?
Up-to-date on vaccinations?
Why aren't they up-to-date on vaccinations?
Add Another
Remove
Pet 3 Name
Type of Pet
Age
Breed
Gender
Are they spayed or neutered?
Why aren't they spayed or neutered?
Up-to-date on vaccinations?
Why aren't they up-to-date on vaccinations?
Add Another
Remove
Pet 4 Name
Type of Pet
Age
Breed
Gender
Are they spayed or neutered?
Why aren't they spayed or neutered?
Up-to-date on vaccinations?
Why aren't they up-to-date on vaccinations?
Add Another
Remove
Pet 5 Name
Type of Pet
Age
Breed
Gender
Are they spayed or neutered?
Why aren't they spayed or neutered?
Up-to-date on vaccinations?
Why aren't they up-to-date on vaccinations?
Remove
Do your current pets or did your former pets receive monthly heartworm and flea/tick preventatives?*
If yes, what brands do/did you use?
If no, why not?
Are any members of your household allergic to pets?*
How will that family member manage his/her allergies with an adopted dog?
Who will be the Primary Caretaker of the dog?*
If the Primary Care Taker is not the Applicant please list relationship to Applicant:
Step 4 of 6

Veterinary Information:

Vet Name*
Vet Phone Number*
Address*
How much do you expect to spend annually on vet care for your dog?
Have you considered the extra expenses that will come with having a dog including vet care, food, supplies, and equipment, toys, training, and boarding ifneeded?
In the case of a substantial veterinary expense due to medical issues how will you navigate the situation?*
Step 5 of 6

Safety questions:

Where will your new dog(s) be kept primarily?
If other, please explain:
Do you have a fenced yard?*
What kind of fence?
Height of fence? (ft)
What is the maximum hours the dog(s) will be left alone on a typical day?
Where will your new dog(s) stay when you are not at home?*
Where will your dog(s) be staying at night?*
Where will your new dog(s) be cared for during overnight absences or while on vacation?*
How do you plan on exercising your dog(s)*
Please select one or more from the dropdown.
Have you ever had a serious behavioral problem with a previous dog?
Please explain this behavioral problem:
How would you handle temperament or obedience problems that might arise?*
It may take 2 to 3 weeks for a new pet to decompress and settle in your home. Are you willing to give the pet time to decompress and adjust?*
Why not?
In the event that the dog you’ve applied for is not housetrained, what methods will you use to house train him/her?*
Please select one or more methods:

If other, please explain:
Have you ever given up a pet?*
Please explain:
What circumstances, in your mind, justify giving up a dog?
Please select one or more from the dropdown.
If you have any other circumstances than the options above:
If you date or marry someone who does not like or want pets, what will you do?*
Can you commit to providing a permanent loving home for this dog for its lifetime, up to 15 years?*
Why not? Please explain:
Do you have any known physical or medical limitations that would affect your ability to care for and exercise a dog?*
If so, please explain how you will get your dog proper exercise.
Are you willing to keep a collar and ID tags on all of your pets, including a new dog, at all times?*
Why not? Please expain:
Have you ever applied to adopt a pet with a rescue group or shelter?
Name of Shelter or Rescue Group
Year of Application
Did you adopt?
Have you ever been denied by a rescue group or shelter?

Step 6 of 6

References:

Reference 1*
Name
Phone Number
Email
Address*
Reference 2*
Name
Phone Number
Email
Address*
Reference 3*
Name
Phone Number
Email
Address*

Signing

By signing below, I am attesting to the truthfulness of my answers. I consent to Braveheart Bulliez Rescue and/or representatives discussing information on this application with any persons named on this application.

Applicant must be 25 years of age or older. Braveheart Bulliez Rescue reserves the right to refuse any applicant for any reason. All completed applications become the property of Braveheart Bulliez Rescue, Inc.

I also acknowledge that there is an adoption fee of $375 for dogs under 8yrs old and $475 for puppies 6mos or younger to offset all care and medical treatment the animal has received.
Typing your full legal name here and submitting this form will serve as your electronic signature:
Today's Date:

Additional comments why you want to adopt:

Thank you!

Your submission has been received.

An email with a copy of this submission will be sent to you within the hour.

Oops! Something went wrong while submitting the form.
Cute Dog Image

Adoption Application

Applications will be automatically emailed to us when you SUBMIT it.

You must be 25 years or older to adopt.

Step 1 of 6

Dogs Information:

Dog(s) name you are interested in:*
Today's Date*

Please select any of the following reasons you will be adopting this dog(s):*
Select One or More Reasons.

Step 2 of 6

Your Information:

Full Name*
Date of Birth*
Email Address*
Phone Number*
Address*

Step 3 of 6

Housing:

Where do you currently reside / live?*
Do you Rent or Own?*
Is there a limit to number of pets you may own?
Is there a weight limit?*
How many times in the last 5 years have you moved?*
Do you plan to move in the next 6 months?*
Does your municipality (State, City, HOA, etc.) have breed-specific restrictions?
Are you willing to have a Braveheart Bulliez Rescue Representative visit your home?*
Will this pet be a surprise for anyone?*
Are there any other adults (21 and older) living in the household?*
Are there any Children (under the age of 20) living in the home?
Do you have any other pets in your current house hold?
Are any members of your household allergic to pets?*
Who will be the Primary Care Taker of the dog?*
If the primary care taker is not the applicant please list relationship to Applicant

Step 4 of 6

Veterinary Information:

Vet Name*
Vet Phone Number*
Address
How much do you expect to spend annually on vet care for your dog?
Have you considered the extra expenses that will come with having a dog including vet care, food, supplies, and equipment, toys, training, and boarding*
Do your current pets or did your former pets receive monthly heartworm and flea/tick preventatives?*
In the case of a substantial veterinary expense due to medical issues how will you navigate the situation?

Step 5 of 6

Safety questions:

Where will your new dog(s) be kept primarily?
Do you have a fenced yard?*
What is the maximum hours the dog(s) will be left alone on a typical day?
Where will your new dog(s) stay when you are not at home?*
Please select one or more from the dropdown.
Where will your new dog(s) be cared for during overnight absences or while on vacation?*
Where will your dog(s) be staying at night?*
How do you plan on exercise your dog(s)*
Please select one or more from the dropdown.
Have you ever had a serious behavioral problem with a previous dog?
How would you handle temperamental or obedience problems that might arise?*
It may take 2 to 3 weeks for a new pet to settle in your home. Are you willing to give the pet time to adjust?*
In the event that the dog you’ve applied for is not house trained, what methods will you use to house train him/her?*
Please select one or more from the dropdown.
Have you ever given up a pet?*
What circumstances, in your mind, justify giving up a dog?
Please select one or more from the dropdown.
If you date or marry someone who does not like or want pets, what will you do?*
Can you commit to providing a permanent loving home for this dog for its lifetime, up to 15 years?*
Do you have any known physical or medical limitations that would affect your ability to care for and exercise a dog?*
Are you willing to keep a collar and ID tags on all of your pets, including a new dog, at all times?*
Have you ever applied to adopt a pet with a rescue group or shelter?

Step 6 of 6

References:

Reference 1*
Name
Phone Number
Email
Address
Reference 2*
Name
Phone Number
Email
Address
Reference 3*
Name
Phone Number
Email
Address

Signing

By signing below, I am attesting to the truthfulness of my answers. I consent to Braveheart Bulliez Rescue and/or representative discussing information on this application with any persons named on this application.

Applicant must be 25 years of age or older. Braveheart Bulliez Rescue reserves the right to refuse any applicant for any reason. All completed applications become the property of Braveheart Rescue.

I also acknowledge that there is an adoption fee of $375 for dogs under 8yrs old and $425 for puppies 6mos or younger to offset all care and medical treatment the animal has received.
Typing your full legal name here and submitting this form will serve as your electronic signature
Date
Additional comments why you want to adopt
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.