1. Your Name  

First Name(s): Last Name(s):

2. E-Mail: 

3. Address: 

4. City: 

5. State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming Canada

6. Zip: 

7. Age: 

8. Home Phone: 

9. Work Phone: 

10. How long have you been at this address? 


11. How long do you plan to be at this address?  


12. Are pets allowed at your residence? yes no

13. Do you own or rent your residence? own rent

14. Is your residence a: Select one... House Condominium Apartment Other

-If not owned.. Landlord's name:

-Landlord's telephone number:

15. Is your residence air conditioned? yes no

16. Do you have stairs at your residence? yes no


-If yes, where are they and how many stairs are there?


17. Is someone home all day? yes no

-If yes, who?

-If no, how long will the dog be alone?


-How often will the dog be left alone?


18. Will the dog be an inside dog or an outside dog? inside outside
-If an outside dog, what provisions will you make to ensure its health and comfort?


19. If you move, what do you plan to do with the dog?


20. Do you have a fenced yard? yes no
-If yes, how tall and what type of fence?


21. Do you have an in-ground pool? yes no
-If yes, what are the provisions to ensure your dog's safety around the pool?


22. Name of veterinarian:

23. Vet's phone number:

24. Please list all pets you currently own. Include type, breed, sex, age and whether they were neutered/spayed. If your pet is not neutered/spayed, why?


25. Please list all pets you have owned in the past. Include type, breed, sex, age and whether they were neutered/spayed and why you no longer have this animal.


26. Have you ever adopted a dog before? yes no
-If yes, adopted from where?


27. Are you familiar with the health problems specific to this breed?
yes no

28. Are there any problems/behaviors you can't/aren't willing to deal with? Please explain:


29. Are you willing to consider an elder or special needs rescue?
yes no

Will you agree to...
30. Heartworm preventive? yes no

31. Prescription flea control? yes no

32. Obedience training? yes no

33. Micro-chips or tattoos for ID? yes no

34. Are you prepared to meet the usual expenses of routine exams, premium dog foods, monthly flea and heartworm medications, etc, in excess of $1000.00 per year, per dog?
yes no

35. Are all family members in agreement of adopting a rescue bulldog?
yes no

36. Do you have children? yes no

-If yes, how many and how old are they?

-Do you plan to have kids in the future? yes no


37. How many adults live in your household?
-If more than you, who and how old are they?


38. Is your vehicle air conditioned? yes no

39. Will you be able to exercise the dog? yes no
-If yes, how often and where do you plan to exercise the dog?


40. Do you have plans for the dog when you go on vacation?
yes no
-If yes, what plans?


41. How do you plan to housebreak the dog (if necessary)?


42. How do you plan to discipline the dog?


43. Do you believe in the use of crates? yes no
-If yes, for what purpose?


44. Do you consider the dog a: Select one... family member working dog guard dog pet other
-If other, explain:


45. Please tell us why the bulldog interests you!


46. Why do you think you and your home/family are perfect for a rescued bulldog?


47. How did you get to (or hear about) our website?
Select one... Friend Search Engine Page Link

Any comments about the foundation or our website?


48. If you are chosen to be interviewed, can you be available with very little notice?
yes no

49. If a dog is placed with you, are you able and willing to make a tax-deductible donation of $325.00 to On The Rebound Bulldog Rescue Foundation to assist future bulldogs in need?
yes no

50. I understand no breed registration papers will be transferred at the time of adoption.
yes no


By clicking on submit below, you are stating, to the best of your knowledge, all information given in this application is true. Any false statements in this application may result in the denial of adoption. In the event that the dog has already been placed in your home, it may be reclaimed without notification or permission from the applicant.

Please press submit only once!