SBRET  ** ADOPTION **  Application


Adoption Policies:
You must be at least 21 years old and live in the East Tennessee area. Current or past dogs must be spayed or neutered, have a history of being kept current on distemper/parvo and rabies vaccines, receive yearly vet exams with heartworm screening and proof of being on monthly heartworm prevention year round. To adopt a puppy younger than six months someone needs to be home at least part of the day to help with house training and socialization. Click here for more information about the adoption process.

You may complete the application below and submit it online, or download the MS Word document to complete and email or snail-mail it to us. A PDF version of the application is also available for you to download/print, complete and snail-mail back to us. You may also complete the form below, print it, and mail it to SBRET at the address listed below. Submitting the information online is the quickest way to provide your information and speeds up the adoption process. Don't forget to keep a copy of the application for yourself.

Complete answers to the following questions enables us to be more familiar with your request and requirements, and will help us find the rescue dog to match your needs and expectations.


How did you hear about us?   If other, please specify:


Name(s):

Home address (include street, city, state & zip code):

Mailing address (if different):

Home phone:    Work phone:

Email address:

Occupation(s):

How long have you been at this address? years and months

Do you  own or  rent?

If renting, please provide landlord's information:

Landlord's name:    Landlord's phone number:

Do you have the permission of your landlord to have a dog? Yes     No

Are you interested in a particular dog? Yes     No

If Yes, which one?

If No, what breed/size are your interested in?

Gender preferred:

Age desired:    

What are you reasons for wanting to adopt a dog at thsi time? (Check all that applyl)
Family Pet
Watch Dog
Companion for current pet
Other (please explain below):

Please share with us any special activities in which your new dog will be participating in as part of the family:

Do you have any children, currently expecting a child, planning for a child, or will children be visiting the home?

Yes     No

If Yes, please give their ages:

Who is the dog primarily for?

Who will have chief responsibility for the care of your new pet?

Does anyone in your household have allergies to dogs? Yes     No

Home visits are a required part of SBRET's adoption process, please give a time(s) that are best to conduct the visit.

Please list individually all pets you have owned within the last 15 years:

 Pet's NameBreedAgeStill living with you?
 1.         Yes   No
 2.         Yes   No
 3.         Yes   No
 4.         Yes   No
 5.         Yes   No
 6.         Yes   No
 7.         Yes   No
 8.         Yes   No
 9.         Yes   No
10.         Yes   No

If the pets listed above are no longer living with you, please explain:


Where do your current pets stay during the day?


Where do your current pets stay at night?


Are your current pets:
  Spayed/Neutered?     Yes   No
  Up to date on vaccines?     Yes   No
  On monthly heartworm prevention?     Yes   No


Have you ever had a pet run away?    Yes   No

If Yes, please explain:

Have you ever had to give up a pet?    Yes   No

If Yes, please explain:

Where will the new dog be during the day?

Where will the new dog be at night?

How many hours will this new pet be alone?

Is your yard fenced in?

Yes     If Yes, what type and height?
    

No     If No, please describe how you plan to monitor your dog when outside on your property:
    

Do you have a swimming pool? Yes     No

If Yes, do animals have free access to it? Yes     No

Where will the dog stay when you are on vacation or out-of-town?

If you move will your dog move with you?
       Yes     No

What behaviors, if any, would cause you to give up your dog?

Please provide the full name, address, and phone number of your current veterinarian:

May we contact your vet for a reference? Yes     No
         Please provide full name account is under:

Please provide the full name and phone number of a personal reference:

If you do adopt a rescue dog and decide to give it up, do you agree to contact us and make arrangements to get the dog back to SBRET?
       Yes     No

Have you or any members of your family/household been cited for leash law violations or cruelty to animals in the past?
       Yes     No

If Yes, please explain:

Have you applied to any other Rescue groups? Yes     No

If yes, please identify the group so that we do not duplicate their efforts:

I/We attest that the Terms and Conditions of Adoption as stated below have been read in full and I/We understand that said terms and conditions are part of the adoption process and will be enforced.         Yes     No

  I/We attest that the information provided on this application is true and accurate to the best of my/our knowledge.

  I/We attest that we have retained a copy of the Terms and Conditions of Adoption and also understand that completion and submission of this application does not in any way guarantee adoption of an SBRET Rescue Animal.

  I/We understand that any misrepresentation of fact may result in the removal of the adopted dog from my/our home.

  I/We understand that if this application was submitted via email, formal signature(s) will be obtained if and when adoption takes place.




If you submit your information online, there is NO need to also mail the information. Mailing address and signature lines are listed below only for those NOT submitting the application online.

Mailing address:   SBRET        
   P.O. Box 22482  
   Knoxville, TN 37933  

Applicant's signature: __________________________    Date: _______________

Co-applicant's signature: __________________________    Date: _______________