Application for Placement
Recycled Rotts, Inc.

Personal Information

Name: Age:
E-Mail address:
Spouse: Age:
Address:
City: State: ZIP:
Cell Phone:     Home Phone:
Will you accept a collect call from us?  Yes       No
Comments on which number to contact you - at which times of the day or week:


Your employer: Phone:
Spouse's employer: Phone:
Number of Children: Their ages:
How long have you lived at this address?
If less than two years, please list your previous address:
Which best describes your current living situation:
Do you:
If you rent, Name & phone number of Landlord:

What type of environment?

Besides your immediate family, are there others residing in your home? Yes       No
Names
Ages:

Does your home have a yard?   Yes       No      Is there a fence?   Yes       No
What type of fence and how tall?
Will gate be locked with a padlock?   Yes       No
Is the fence secured underground as well?   Yes       No


Placement Information

Is someone home during the day?   Yes       No
If no, where will the dog stay while you are gone?
Where will your dog be kept most of the time? In house Outside Basement
Other: (specify)
If kept outside, will you have a dog run/dog house?   Yes       No
(Dogs are not to be chained or tied out and left at any time)

Will you take your dog to obedience class?   Yes       No

Have you ever owned a Rottweiler?   Yes       No
Tell us about your rotts?


Do you prefer a male or female Rottweiler (click both if either is ok)? Male     Female
Age range?
Is there a dog on our web page that you are interested in?   Yes       No    Which one?

Why do you want a Rottweiler?


Will the Rottweiler be used as a guard dog?   Yes       No
Explain:
What other activities do you plan to do with your Rottweiler?



Other Pet Information

Do you have other pets? Type:
Are your other pets current on all vaccinations?
Are your animals on heartworm preventative?   Yes       No
What type?
Are you willing to pay for a heartworm test?   Yes       No

Veterinarian's Name & Phone Number:
If applicable, approximate date of your current pet's last office visit:
If you have owned other dogs and do not now, what happened to them?

How did you hear about Recycled Rotts, Inc.?
List any Humane Societies, Organizations, Breed or Training Clubs you are associated with:

We will attempt to provide you with an honest evaluation of temperament on any dog we have to place. Do you realized that often times the complete history of a Rottweiler may not be known and you may encounter some behavioral problems? Are you willing to work with us on correcting these problems?

Please provide the name, address and phone number of three references:


Space for additional comments:

I certify that the information provided on this form is true & correct. I am also financially and physically able to care for this animal. I understand that proper food and veterinarian care can be costly and I am able to meet these requirements. Home checks are made on a random basis following or prior to adoption. If upon inspection we find that information contained in this application to be false, we retain the right to turn down or remove the animal from your premises without a refund of moneys paid.

 

Signature  
Date  

We require a hard copy of your signature prior to adoption certifying the above information. You may also print the form out and mail it, with your signature to:

Recycled Rotts, Inc.
PO Box 1082
Oswego, IL 60543

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• All rights reserved • Updated 5/6/04