Name:

Full Street Address:
Street Line 1:
Street Line 2:

City:
State:      Zip Code:

Home Phone:       
Fax Number:       
Work Phone:
Email Address:

Occupation:

Employer:

How Long With Employer?   years  months

Spouse Information ---
Spouse's Name:

Spouse’s Occupation:

Work Phone:

Which Bullmastiff(s) are you specifically interested in?

Have you owned other pets before? Owned Pets Before Yes No    
IWhy do you want a Bullmastiff now?

Do you still have the pets listed above?  Yes No N/A  
If YES, list kinds and number of pets you have owned in the past:
Include the TYPE of pet (dog, cat, bird, etc.) and the BREED of pet (Bullmastiff, Siamese, Parrot, etc.) and HOW MANY of each kind.

If you do NOT still have the pets listed above and what happened to the pet(s)?

How many pets do you currently own?  
List species (dog, cat, bird, etc), gender (male, female), size in pounds, age, how many you own of  each, etc. below:
Species---------Gender--------Size--------Age----------Number Owned of Each

Are ALL of your pets spayed or neutered? Yes No N/A    If NO, why not?

State specifically why you want a Bullmastiff:

Have you ever owned this breed before? Owned Bullmastiff Before Yes No

What specifically have you done to educate yourself about the Bullmastiff breed:

Please list your preference regarding:

• Age of Bullmastiff (list minimum and maximum)
  minimum years to maximum years
  NOTE:  The average age of a Rescued Bullmastiff is 4 years old.  We rarely get in Bullmastiffs that are less than 2 years old.
• Sex of Bullmastiff:: No Preference Male Female    
• Color of Bullmastiff: No Preference Fawn Red Brindle

Will you consider something other than your stated preference? Yes No

Should your application be approved and a Bullmastiff is available, how many miles are you willing to drive to pick up a dog?  miles

Should your application be approved and a Bullmastiff is available, are you willing to pay the costs of shipping a dog to your residence?  Yes No

List names and ages of all members within your household
List names and ages of all the human members living within your household

Do you own or rent your home?  Own Rent

If RENTING - do you have your landlord's permission to keep dogs?   Yes No N/A

Can you provide us with such permission in writing?  Yes No N/A

How long have you lived at your current address?  months  years

Where will you keep the dog:

• during the day?

• during the night?

• during family absences overnight?

•  while on vacation?

•  while on business trips?

Do you have a fenced yard? Yes No      If YES, how large an area is fenced in:
  

What kind of fencing and how high is it?

If you do NOT have a fenced yard:

• how will you exercise the dog?
  

• confine the dog?
  

• provide for his/her need to eliminate?
  

What is the maximum number of hours your dog will be left alone during a 24-hour period:

Where will he/she spend this time?

Do you object to the discriminate use of a crate?  Select One Yes No   
Do you have one?  Select One Yes No   Would you get one? Select One Yes No

What will you do if your dog is destructive when left alone?

What kind of vehicle will you use to transport your dog?   Please state the make and model of your car or truck (i.e. Ford Ranger).  If using a truck, indicate if your truck has a camper or not.

Are you willing to attend obedience classes with your dog?    Yes No

Have you ever surrendered a pet of yours to an animal shelter?   Yes No
If yes, why?

Have you ever sold or given away one of your pets?  Yes No
If yes, why?

Have you ever trained a dog before?  Yes No
If YES, describe the training:

Can you afford to spend at least $1000 or more per year for food and routine medical care for your pet? Yes No

Has anyone in your immediate family/household ever been convicted of a charge related to cruelty to animals or child abuse?   Yes No

Is there any such charge pending?   Yes No    Has any such charge ever been filed?  Yes No
If yes to any of the above, please explain and give disposition of charge.

List your regular veterinarian(s)' information:
Name of Clinic:
Name of Vet:
Street Address:
City:  
State     Zip Code
Phone Number (include area code)
Additional vet information:

Please provide the names and phone numbers (include area code) of two nonrelated individuals who can serve as references:

Please provide the following information on your nearest living relative:
Name:
Street Address:
City:  
State   Zip Code
Phone Number (include area code)

May we visit your home and check your references to verify the information you have provided? Select One Yes No

After adopting a Bullmastiff, an injury/illness requires that your Bullmastiff have a $1500 surgery in order to repair the injury/illness. What would you do?

What are the requirements for dog ownership in your community?

How many pets may you legally have? 

Are dogs required to be vaccinated against rabies?  Yes No

Is there a leash law?  Yes No

What will you do with your dog if you move?

What will you do with your dog if you decide to have children (or more children if you already have children)?

What will you do with your dog if you decide to get married/divorced?

Is anyone in your household allergic to dogs?  Yes No

How much time per day will you spend with your dog?
  

What kind of dog food will you feed?  Name brand names that you will be using:

What hobbies do you have in which you could include your dog?

What circumstances, in your mind, justify getting rid of a dog?

What would you do with the dog if the above circumstances occurred?

What do you and your home environment have to offer a Bullmastiff that has been neglected/abandoned?

How did you find out about us?  

Thank you for taking your time to complete this application. By typing your name below you attest to the truthfulness of your answers. Falsification of any of the above information will be grounds to disallow your adoption of a rescued dog.

Applicant Signature

By entering your Date of Birth, you attest that you are at least 21 years of age: 
Date of Birth 

Applicant Signature 

By entering your Date of Birth, you attest that you are at least 21 years of age: 
Date of Birth 

(If there are two responsible adults in household, both must sign as an applicant.)

Please press the button where you would like to have your application sent to: