Date:

Name:

Age:

E-Mail:

Address:

City:

State:

Zip:

Home Phone:

Work Phone:

Sexual Preference: No Preference Neutered Male Spayed Female

Color Preference: No Preference Brindle White Red or Fawn Piebald

Age:

Do other adults live in your home? Yes No

How many? 1 2 3 4 5 More than 5

Do any children live in your home? Yes No

How many and what ages?

Is any member of your household allergic to animals? Yes No

Will you be primarily responsible for the care of this dog? Yes No

If not, who will be?

Do you own any other dogs? Yes No

If yes, please complete:

Breed

Age

Sex (Spayed / Neutered)

Do any other pets live in your home? Yes No

If yes, what?

Are you familiar with the health problems associated with short-nosed dogs? Yes No

Where do you live? House Condo Apartment Other

If Other, please specify

Do you... Own Rent

If you rent, are pets allowed? Yes No N/A

Where will the dog live? In house In yard In garage Other

If Other, please specify

Do you have a fenced yard? Yes No

If yes, type and height?

Do you have a pool? Yes No

If yes, is there a barrier to prevent the dog from falling in and drowning? Yes No N/A

Is someone home during the day? Yes No

If not, where will dog stay?

For how long?

Is someone home at night? Yes No

If not, where will dog stay?

For how long?

Do you plan on traveling with this dog? Yes No

If not, where will dog stay?

Are you a member of any dog clubs, SPCA, Humane Society, etc? Yes No

If yes, what?

If married, does your spouse approve of getting a dog? Yes No

Do other household members approve of getting a dog? Yes No

I understand that dogs placed by The Bulldog Club of Central Florida Rescue Network have been acquired, fed and boarded, received medical care and inoculations, been spayed / neutered, and been tested to be free of heartworm and contagious disease at the personal expense of the volunteers who comprise the Rescue Network and who receive financial compensation only as it is available through donations.

I can can not make a donation of at least $ 300.00 to The Bulldog Club of Central Florida Rescue Network to help rescue, provide medical care for, spay/neuter, placement and follow-up of other unwanted and abandoned bulldogs. (Inability to make a donation to the Rescue Network does not disqualify an application from consideration.)

I do do not have an interest in any pet store, commercial breeding kennel, buying of dogs for resale.

I have have not been convicted of cruelty to animals.

I am am not under suspension from any purebred dog association.

How much do you anticipate spending for this dog annually to feed, vaccinate, license, and provide medical care? (This question is intended to evaluate your familiarity with the special needs of this relatively "high maintenance" breed, so we can more adequately provide educational material to you.)

Why are you interested in adopting a bulldog?
Please enter why you are interested in adopting a bulldog here.

Your veterinarian:

Vet's Address:

Vet's City:

Vet's State:

Vet's Zip:

Vet's Phone Number:

I hereby make application to The Bulldog Club of Central Florida to have my name added to the waiting list for the purpose of giving a bulldog a permanent home. I have answered all of the above questions truthfully and to the best of my knowledge and ability.

Type Your Name: Date:

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