Online Application Form

We Love our Dogs

Please fill out all fields marked with a "*"

Personal Information:

*First Name:

*Last Name:

*Address Line 1:

Address Line 2:

*City:

*State/Province:

*Zip Code:

*County:

*Country:

*Email:

*Home Phone:

Cell Phone:

Your Age:

Your Family and Pets:

Please list the Relation,
Age and Name of Family members:

	Relation	Age	Name
1.
2.
3.
4.
5.

Please list the current pet Type (cat, dog, etc.), Breed, Age, Altered, Source and Years Owned:

	Type & Gender	Breed	Age	Altered	Source	Years Owned
1.
2.
3.
4.
5.

Please list the Previous pet Type, Breed, Age, Altered, Source and Years Owned:

	Type & Gender	Breed	Age	Altered	Source	Years Owned
1.
2.
3.
4.
5.

Reference #1: Please list your veterinarian as your first reference

*First Name:

*Last Name:

*Address Line 1:

Address Line 2:

*City:

*State/Province:

*Zip Code:

*Country:

*Email:

*Home Phone:

Cell Phone:

Relationship:

Reference #2: Please list someone not related to you as second reference

*First Name:

*Last Name:

*Address Line 1:

Address Line 2:

*City:

*State/Province:

*Zip Code:

*Country:

*Email:

*Home Phone:

Cell Phone:

Relationship:

Reference #3: Please list a relative or non relation for reference third reference

*First Name:

*Last Name:

*Address Line 1:

Address Line 2:

*City:

*State/Province:

*Zip Code:

*Country:

*Email:

*Home Phone:

Cell Phone:

Relationship:

Your interest in Ridgebacks:

*Please describe your reasons for choosing the Rhodesian Ridgeback as your preferred breed:

*Have you Previously been owned by a Ridgeback? If so, please describe the experience:

*Please describe your reasons for choosing to adopt a rescued Ridgeback:

*What makes you a good pet owner:

*Have you ever bred dogs? If so, please describe the circumstances and breed:

*Have you ever shown dogs? If so, please describe the experience and breed:

*Please describe any Previous dog training you may have done:

*Please list any books you may have read about Ridgebacks, dog training, or dogs in general:

Care and Training:

*Where will the Ridgeback sleep?

*Do you plan on using a crate? Please explain why or why not:

*Please describe the feeding routine you plan to use:

*How many hours per day will the Ridgeback be alone?

*Please describe how an adopted Ridgeback might be expected to spend it's days in your home:

*Please describe how an adopted Ridgeback might expect to be exercised:

*Please describe what activities you plan to share with your Ridgeback:

*Who will be the primary care giver of the Ridgeback?

*Please describe the activity level of your home:

*Are you financially prepared to provide regular veterinary care?

*Will you keep the Ridgeback on heartworm medication year round??

*What types of behavior traits would you be willing to Work on correcting?

*What types of behavior would you not be willing to Work on correcting?

*In your absence, who will care for the Ridgeback?

*Do you plan on taking the Ridgeback to obedience classes? Please describe why or why not:

*Have you ever given up a dog in your care to a shelter or other rescue group? If so, please describe the circumstances:

*Are you willing to care for the Ridgeback for 10 or more years?

*One of the provisions of our adoption contract is that all dogs will be spayed or neutered prior to placement. Are you in agreement with this policy? Why or why not?

*In the event that you were unable to care for your Ridgeback, what provisions would be made for the Ridgeback?

Dog Preferences:

How soon are you looking to adopt:

*Gender Preference (all dogs are spayed/neutered prior to adoption):

*Would you accept a ridgeless dog?

Yes No Explain:

*Would you accept a mixed-breed Ridgeback?

Yes No Explain:

*Would you be willing to adopt a dog with special needs?

Yes No Explain:

Where did you hear about us?:

Agreement:

I (We, the above-named Applicant(s) , hereby agree to release, indemnify, defend and hold Ridgeback Rescue of the United States, its officers, directors, volunteers, and their successors and assigns, harmless from and against any liability, claim, damage, injury, cost, or expense whatsoever relating to the adoption of any dog from Ridgeback Rescue of the United States.

Name: