Adoption Form Page 1 of 7About YouName*FirstLastCountry*Please selectUSCanadaAddressAddress Line 1*Address Line 2City*State*Please selectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip*AddressAddress Line 1*Address Line 2City*State*Please selectAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonZip*Phone*When is the best time to call?*E-Mail*Do you use Facebook? if so, what is your username?*What is your occupation?*Length of time at your current employer?*What is your spouse/significant other's name and occupation? (If applicable)Email address*NextBull Terrier PreferencesAre you financially ready for a bull terrier? *(vet checkups, vaccines, flea/tick/heartworm prevention, food, bowls, vitamins, bedding, crate, leashes/collars, treats, toys, grooming/shampoo, training, boarding, emergency medical costs, etc.)Are you applying to adopt and/or foster?*AdoptFosterDo you prefer male or female?*MaleFemaleNo PreferenceDo you prefer white or colored?*WhiteColoredNo PreferenceIs there a specific Bull Terrier that you are interested in fostering/adopting from BRBTC?*What age limit you are willing to adopt up to?*What type of personality and activity level would you prefer your new bull terrier to have?*BackNextYour HomeWhat type of home do you live in?*Please selectSingle Story HomeMulti Story HomeApartmentCondoTownhomeMobile HomeHow many steps/stairs to get in/out of your home? (Senior or special needs dogs)*Number of years at current address:*Do you rent, own or live with family/friends?*Please selectRentOwnLive with FriendsLive with FamilyDo you have plans to move within the next year?*Does anyone in your home smoke?*Please selectYesNoWhere? (indoors, outdoors, both)*Do all members of your household agree on welcoming a bull terrier into your home?*Please selectYesNoExplain*BackNextYour Yard & PetsWhat size of yard does your home have?*Do you have fencing?*Please selectYesNoPlease describe the fencing (fence height, fence material, shared fence, whole or partial yard, etc):*Are you willing to install fencing? Please explain:*List all members of your household and include ages:*Do any members of your household have allergies to dogs?*Please selectYesNoList all animals currently in your household:*type, age, sex, neutered/spayedList all animals you've owned previously and what happened to them:*BackNextQuestions, Part OneIf you found out you had to move and were having difficulty finding a dog friendly home, what would you do?*In your mind, what circumstances justify giving up a pet?*Have you ever had to surrender a pet? If yes, please explain:*Do you have prior bull terrier experience? If yes, please explain:*Why do you and/or your family want a bull terrier? What do you know about bull terriers?*How would you react if the bull terrier destroyed something in your home or had an potty accident indoors?*BackNextQuestions, Part TwoWho will be the primary person responsible for the bull terrier?*Where will your bull terrier stay during the day?*Where will your bull terrier sleep at night?*How long will your bull terrier be alone on an average day*What type and length of exercise will your bull terrier get on an average day?*Are you willing to take your bull terrier to obedience classes if needed?*Please selectYesNoWhat are your average weekend activities*How often do you vacation? Where will your bull terrier stay during this time?*Describe the activity level in your neighborhood.*Are there loose or wild animals in your neighborhood?*BackNextLegalitiesIs there a leash law in your town?*Please selectYesNoI don't knowIs there a breed specific law in your town?*Please selectYesNoI don't knowBRBTC does not approve, condone, or allow the use of off-leash dog parks for our fostered and/or adopted bull terriers. Do you acknowledge and agree to abide by this rule? (Please type "I AGREE" in the box below)**List name, address, and telephone number of your veterinarian:*List two personal references (name, address, and telephone):*Are you willing to have a member of the BRBTC visit your home prior to adoption?*Please selectYesNoAre you aware of the BRBTC adoption fee of $400?*Please selectYesNoHow did you hear about the Blue Ridge Bull Terrier Club?*Additional comments (if any):BackSendThis field should be left blank