First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Work Phone
x

Cell Phone*

Alt Email

Text/Pager Email

Please complete this form to apply to adopt one of our dogs:

• You must be 21 years of age of older.
• Have identification showing current address.
• Must be able and willing to spend the time and money necessary to provide training, medical attention, and proper care for a pet.
• Your current pets must be spayed/neutered, current on vaccinations, and heartworm preventative (dogs only).
• Adoption fee payment methods - cash, personal check (with a valid, local, Texas driver’s license).  Credit cards accepted with a $5 convenience fee. 

​​ Please complete all relevant fields. Those marked with an asterisk are required before you can submit the form. We will contact you as soon as possible after receiving your Adoption Application. Please be patient, but if you have not heard from someone within 48 hours, please send an email to JBsRescue@gmail.com

Name of dog you would like to adopt?*
Choose an animal: Bella Mia Boyd Buttercup Charlie Dusty French Fry Ginger Lacey Lalo Marble Moon Patches Peaches Phoenix Potato Spunky Sweet Pea Tortellini

Your Age?*
Choose one: Under 21 21-25 26-35 36-45 46-55 56-65 66-75 76-80 Over 80

Will this be your first experience with a pet?*
Choose one: Yes No

Have you ever adopted a pet before?*
Choose one: Yes No

If so, Name of Shelter or Rescue Organization

Have any of your pets (past or present) been diagnosed with an infectious disease, such as Distemper or Parvo?*
Choose one: Yes No

Currently, how many pets are living with you?*

Please list all pets living with you currently (Name, Dog/Cat, Breed, Age, M/F, Spayed/Neutered, Kept Where?*

Name and telephone number of your current Veterinarian?*

Please list all pets (dogs and/or cats no longer living with you) you have owned in the past 5 years: Name, Dog/Cat, Breed, Age, M/F, Spayed/Neutered, Kept Where, and Reason No Longer with You?*

Name and telephone number of veterinarian who treated your previous pets?*

What type of residence?*
Choose one: House Duplex Condominium Apartment Mobile Home Other

Do you Own or Rent your home?*
Choose one: Own Rent

How long have you lived at your current address?*

If you were to move, what would you do with your pet?*

How many times a year do you travel?*

Where would your pet stay when you go out of town?*

How many people live in your household?*

List ages of any children living in household*

Is anyone in household allergic to animals?*
Choose one: Yes No

Do you have the consent of all adults in this household to adopt this pet?*
Choose one: Yes No

Who will be primarily responsible for care of the pet?*

Where will this animal be kept during the day?*
Choose one: Garage Crate Outside Mostly Outside Inside Mostly Inside

Is anyone home during the daytime?*
Choose one: Yes No

How many hours at a time will this pet spend alone?*

Where will this pet be kept at night?*
Choose one: Garage Crate Outside Mostly Outside Inside Mostly Inside

Are you familiar with the leash, licensing and HOA rules in your community?*
Choose one: Yes No

Do you have a fenced yard?*
Choose one: Yes No

If so, how high is the fence?*

If you have a fence, what type - wood/chain link/wrought iron/electronic/other*

Do you have shelter or a doghouse in your backyard?*
Choose one: Yes No

Do you have a dog door installed in your house?*
Choose one: Yes No

Do you have a pool?*
Choose one: Yes No

Would you housetrain a dog?*
Choose one: Yes No

Do you plan to take your dog to obedience class?*
Choose one: Yes No

If you have dogs, are they on heartworm preventative?*
Choose one: Yes No

Which Brand of Heartworm Preventative do you use?*

How do you plan to transport your dog?*

No dog is perfect. Please check ALL behaviors you are unwilling/unable to work through.

Comments - Please add any additional information here.

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