North Carolina Rottweiler Rescue Adoption Application“Rescued from Doubt, Placed with Love”The information you provide on this application will help us to find the most suitable dogfor your family. Please print it out and fill it COMPLETELY, and mail to: North Carolina Rottweiler Rescue-Adoption5613 Old Ridge RoadRaleigh, NC 27610Please do not forget to include a $25 check made payable to North Carolina Rottweiler Rescue for the application donation. No application will be processed without submitting$25. Thank you.

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***North Carolina Rottweiler Rescue Reserves The Right To Deny Any Application For Any Reason*** Personal Information: Name: ________________________________ Age: _____________ Spouse: ________________________________ Age: _____________ Address: ________________________________ ________________________________ ________________________________ Phone: _________________________ Home_________________________ Your Work and hours _________________________ Spouse's Work and hours

Email: _________________________________ Employer: _________________________________________________________ Spouse's Employer: _________________________________________________________ Number of Children: ________ Names Ages____________________________ ______ ____________________________ ______ ____________________________ ______ ____________________________ ______ Have any of these children been exposed to large breed dog before? _____Yes _____NoHave any of these children been biten by a dog? ___ Yes ___ NoIf yes, please explain the circumstance:If you do not have children, do you plan to have children some day?If yes, explain how this will affect the dog's placement in the household:Please circle which of the following best describes your current living situation:1. House Condo Apartment Mobile Home2. Rent Own Live with parents3. City Suburban CountryIf you rent:Does your landlord allow pets? ____ Yes ____ NoIs there a pet deposit? _____ Yes _____ NoIf yes, how much money per pet or per household?

Is there a size or weight limit? ____ Yes ____NoIf yes, what is the limit?What is your landlord's name and phone number? _____________________________________________________________ How long have you lived at this address? _________________ If less than 2 years, please list your previous address: ______________________________________________________________ If requested, renters must provide landlord statement/copy of lease indicating that aRottweiler may live on the premises,address and phone number. Name of Homeowner Insurance Company:__________________________ Insurance Agent Name and telephone number: ________________________ Are they aware that you may have a Rottweiler as a companion pet?____ YES _____ NOBesides your immediate family, are there others residing in your house? ___ YES ___ NODoes anyone in your home have allergies or asthma:If yes, names and relationship: ______________________________________________________________ ______________________________________________________________ Does your home have a yard? ___ YES ___ NOIf yes, is it fenced? ___ YES ___ NOWhat type of fence? _______________________________________ How tall is the fence? _______________________________________ Will the gate be locked with a pad-lock? ___ YES ___ NOIf you do not have a fenced yard, are you prepared to walk your dog on a