DBMB Guardianship Application Form

Guardianship Application
Thank you for your interest in fostering/adopting one of our current adoptable pets. However, in the interest of everyone involved including our animals, we will only consider applications with the following minimum criteria:

1) You are at least 21 years of age.

2) Your current housing has no breed and/or weight restriction where if an animal being adopted by you will result in an issue with your housing status, i.e. check with your landlord or property management company for specifics regarding breed and/or weight restrictions in regards to pets.

3) You are located within 1.5 hours of Chicago, IL or Peoria, IL and/or local resources are readily available, i.e. vets and trainers.

You can also check on Petfinder or Pit Bull Rescue Central for an organization near you if you do not meet the above minimum criteria.

Thank you,
The Dont Bully My Breed Team
Type of Application*

AdoptionFosterBoth (either/or)
Primary Adopter*

First NameLast Name
Primary Adopter's Age*
Secondary Adopter

First NameLast Name
Secondary Adopter's Age
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Primary Phone Number*

Area CodePhone Number
Secondary Phone Number

Area CodePhone Number
Work Phone Number

Area CodePhone Number
Do you rent or own*

RentOwnLive with ParentsOther
Length of time at present address*
If Renting: Please indicate landlord contact information (Name, Phone number, and Email address)
Household Setting

RuralSuburbanUrban
Describe your Homes Activity Level

Busy/NoisyModerate Comings/GoingsQuiet with Occasional Guests
Number of adults in the household (18 or over)*
Number of children in the household (under 18)*
Please List all People Living in the Household (Include Name, Relationship, Gender and Age)*
Does Anyone in your Household have Allergies to Animals?*

YesNo
Are all members of your Family agreeable to Adopt/Foster a Dog?*

YesNo
When were you hoping to adopt/foster

ImmediatelyNext few daysNext few weeksNext few monthsNot sure
Type of companion animal you are looking for

PuppyYoung dogAdult dogSenior dogNo Preference
Please list any specific dog(s) you are intereted in
Please select characteristics that are most important to you*

Good with all dogsGood with some dogsGood with catsGood with kidsHousebrokenEnergeticMellow
List any other specific characteristics that are important to you
Why are you interested in adopting a pet? (check all that apply)*

GiftTo breedFor protectionFor a childCompanion for meReplace previous petOther
How long have you been considering adopting a companion animal?*
Is this your first companion animal?*

YesNoOther
Do you currently have other companion animals?*

YesNoOther
Please List any Pets you have Living or Deceased (Please include Name, Breed, Age, Altered, Sex, UTD Vaccines, Heartworm, Living/Deceased)*
Have you ever applied to this rescue before?*

YesNo
Have you applied to any other rescue organizations before?*

YesNo
If yes, please list them as it may expedite the processing of your application. Please include the date you applied.
How do you plan to introduce your companion animal to other animals and/or people in the household? *
Are you prepared to spend several weeks or, perhaps months, waiting for your new companion animal to adjust to their new environment? And for you to adjust to this animal? *
How many hours in a day would the dog be left alone?
What are you plans to exercise your dog? Please list any parks near by or trails, how many walks a day, approximate length, and activities such as agility.
Who is or will be your Veterinarian? Please list name, address, and phone number
How much money do you anticipate on spending on your new companion animal's annual doctor visits? *
What yearly vaccines will your companion animal receive? *
What is the longest period of time you would leave your companion animal unattended outside? *
Do you have a completely fenced in yard?

YesNoOther
If yes, how high is your fence?
Which of the following do you have? (select all that apply)

Outside dog runDog houseTraining crateBasementGarageDoggie doorBalconyOther
Where will your companion be kept during the day?*
Where will your companion be kept at night?*
What is the longest period of time your companion will be left alone?*
What brand of food will you feed your companion?*
What are your beliefs regarding spaying/neutering?*
What are your beliefs regarding obedience training?*
What training method(s) have you been exposed to?

Traditional using physical correctionsPositive using clickerPositive using "rewards""Dog whispering"Other
Who will be primarily responsible for feeding/caring for your new pet? *
What do you believe is the average life expectancy of a dog/cat?*
How did you hear about our rescue?*
Have you ever turned an animal into a shelter?*

YesNoOther
If yes, what were the circumstances?
Have you ever rehomed an animal?*

YesNoOther
If yes, what were the circumstances?
How would you handle destroying/scratching the furniture? *
How would you handle jumping on furniture/counters/tables? *
How would you handle chewing?*
How would you handle barking?*
How would you handle urinating/defecating where it is not acceptable? *
How would you handle being kept awake at night?*
How would you handle excessive shedding?*
How would you react if the animal ruined your favorite article of clothing?*
How would you handle biting/play biting?*
Does anyone in the household currently have pet allergies? If so, how do you manage that?*
What would you do if someone in the household were to develop allergies to your companion animal?*
What would you do in the event of medical expenses (emergencies and/or diagnosis of a medical condition)?*
What would you do in the event you had to move?*
When home alone where will the dog be? (check all that apply)*

In a plastic crateIn a wire crateIn a dog pen insideIn an indoor kennelTied up outside with a cable runTied up outside on a chainLoose indoorsLoose outdoorsOther
If there is something else you will do with the dog when it is home alone, please specify:
How will you exercise the dog? (check all that apply)*

Leash walks every dayCable or dog run in the yardWill be free to run in fenced yardWill have supervised off-leash exercise in unfenced areaWill be free to roam aroundWill bring to dog park (public area where dogs can run and play together off-leash)Other
If there is another way the dog will get exercise, please specify
Please list 2 personal references with names, addresses, phone numbers and relationship. We prefer it not to be all relatives.
Reference #1: Full Name*

First NameLast Name
Relation to applicant(s):
E-mail
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Reference #2: Full Name*

First NameLast Name
Relation to applicant(s):
E-mail
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully.

I certify that the information I have provided is accurate and honest and I understand that the information will be verified.
Date*

MonthDayYear
Your name*
Electronic signature (for touch-enable devices)

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