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Adoption Application Form

CONTACT INFORMATION

Name of Applicant Name of Co-Applicant
Driver's License # Email Address
   
Physical Address (where bully will be located) Home Phone
City, State, Zip Code Cell Phone
Employer Work Phone
   
Are you at least 21 years of age or older?  
  Yes     No  
   
Work Schedule: When would be the best time to contact you?
 Sunday
 Monday
 Tuesday
 Wednesday
 Thursday
 Friday
 Saturday
 Morning
 Afternoon
 Evening
 Night
   
Would you be interested in receiving email updates about STXBA news and upcoming events?
  Yes     No  
   
How did you hear about South Texas Bully Alliance?  

QUESTIONAIRE

1. Do you live in a: 2. Do you:
 House
 Condo/Townhome
 Apartment
 Mobile Home
 Own
 Rent
 Lease
 Other
   
3. If you rent or lease, does your lease allow pets? 4. If yes, are there any breed or weight restrictions?
 Yes     No  Yes     No
   
5. If you are renting, please provide your landlord's contact information:
Landlord's Name Landlord's Phone
   
6. Will your bully be a surprise for any family members? 8. Please list all members of your household: Age
  Yes     No 1.
7. If no, do all family members agree to this adoption?
 Yes     No
2.

9. Do any family members have allergies?
 Yes     No
3.
  4.
   
  10. If yes, are they allergic to pet dander?

 Yes     No
   
11. Why do you want to adopt a bully? 12. What would you do if your bully was lost or stolen?
 Family Pet
 Protection
 Companion
 Hunting dog
 Guard dog for business or home
 Companion for other pet
 Other
 Nothing
 Post flyers
 File a police report
 Search local shelters
 Contact other rescue organizations
 Notify STXBA
   
13. Dog Experience: 14. Do you have any experience with bully breeds?
 First time owner
 Owned one or two
 Expert
 Yes     No
If yes, which breed?
   
15. How many hours a day will your bully be left alone? 16. Do you plan to keep your bully:
 Less than 12 hours
 Part of the day
 All day
 Indoors
 Outdoors
 Both
   
17. Where will your bully be kept during the day? 18. Where will your bully be kept during the night?
   
19. Do you have a fully fenced yard? 20. Have you ever adopted from a rescue group or shelter?
 Yes     No  Yes     No
If yes, what type of fence and how high? If yes, what group/shelter?
   
21. Do you have any other pets? 22. Are all of your pets current on vaccines?
  Yes     No  Yes     No
   
23. If yes, please list all of your current pets.  
Type
Breed
Age
Sex
Altered
   
24. Do you agree to keep your bully on a heartworm preventative?
 Yes     No  
   
25. What will happen to your bully if you decide to move or have to move unexpectedly?
   
26. What will happen to your bully when you go on vacation or in case of an emergency?
   
20. Who will care for, train, and exercise your new bully?
   
28. Under what circumstances would you consider getting rid of your bully?
  Moving
  New baby
  Divorce
  Getting out of fence
  Behavioral problems
  Too time consuming
  Unable to potty train
  Medical problems
  Aggressive behavior
  Other
 
   
29. If you were unable to keep your bully, do you agree to return it to STXBA?
(Please note that the adoption fee is non-refundable as the funding is used towards other rescues.)
  Yes     No     Initials  
   
30. Do you give permission for a South Texas Bully Alliance representative to visit your home prior to adoption to do a home check and after adoption to do a follow up?
 Yes    No     Initials  

PREFERENCES

Age Training
 No preference
 6 months - 1 year
 1 - 4 years
 Senior
 None
 Housebroken
 Some obedience training
 Fully trained
   
Activity Level Sex
 No preference
 Low
 Medium
 High
 No preference
 Male
 Female

REFERENCES

Veterinarian's Name Business Phone
Business Address City, State, Zip Code
   
If you do not have a veterinarian, list 2 references. One of your references must be a neighbor.
Name Phone
Address City, State, Zip Code
   
Name Phone
Address City, State, Zip Code
  I certify that the information provided on the South Texas Bully Alliance Adoption Application is true, complete, and correct. I am aware that falsification or misrepresentation of the above information will result in rejection of this application and/or possible removal of an adopted bully from my home.
    
South Texas Bully Alliance reserves the right to refuse any applicant.