Your Name (required)

Your Email (required)

Home Phone & Cell Phone

Address

Which dog are you interested in?

Of all the breeds you could have chosen from, why a Pit Bull?

What drew you to this particular dog?

Your Age

Occupation

Name of Spouse/Partner

If the relationship were to change, who would keep the dog?

References

Employer/Address/Work Phone

Personal Reference(s)/Phone

Vet/Address/Phone

Your Family

How many other people reside in your household?

If you have children, what are their ages?

Who will be the dog's primary caretaker?

Do all members of the household want a pet?
 Yes No

Do any family members have asthma or allergies?
 Yes No

Do you currently own or have you owned a pet before?
 Yes No

If yes, how long did you have your pet(s)?

If no longer with you, what happened to him/her? (If passed away, please give circumstances)

What pets currently live with you? (please give numbers, ages, breeds and sexes)

Are they all spayed/neutered?

Your Home

How long have you lived at your current address?

If you live in an apartment condo, what is their weight limit for a dog?

Do you rent or own your own home?
 Rent Own

If you rent, please provide the contact information for your landlord

IMPORTANT: Many homeowner's insurance companies have breed blacklists which include, but are not limited to, Pit Bulls, American Pit Bull Terriers, American Staffordshire Terriers, Staffordshire Bull Terriers, Rottweilers, Dobermans, Akitas, American Bulldogs, Chows and Wolf-hybrids and will not insure you if they reside in your home or may cancel your insurance if you add a dog of these breeds to your home. Please check your homeowner's insurance policy regarding breed discrimination before submitting this application to adopt a Pit Bull-type dog. Landlords may also have these same breed restrictions due to their insurance policies. Please check this out before applying to adopt one of these breeds.

Do you have a yard?
 Yes No

Is the yard completely fenced?
 Yes No Partial

If yes, what type of fence?

If yes, approximately, how high is the fence at the lowest point?

Do you have a pool?
 Yes No

If yes, is there a fence around the entire pool?
 Yes No Partial

Your Lifestyle

Why are you considering adding a pet to your life? (check all that apply)
 Companion for children Companion for adults only Companion for other pets Working dog Protection for home/family

Other

If you checked the "Protection for home/family" box, please explain

Will you be giving this dog as a gift?
 Yes No

Is the recipient of the gift aware of your intentions?
 Yes No

Where is your pet going to be when you are home? (check all that apply)
 Dog will be a house pet, living inside with the family Dog will live in the basement or garage primarily Dog will live outdoors primarily Dog will live in a fenced dog run with a dog house Dog will have a job as a guard dog for business/residence

Other

If you checked the "Guard dog" box, please explain the nature of the dog's responsibilities

On average, how many hours per day will your pet be left alone?

When home alone dog will be (check all that apply)
 In a crate, wire crate or dog pen inside In an enclosed kennel outside Tied up outside on a cable run or with a chain Dog will be loose indoors Dog will be loose outdoors

Other

How do you plan on keeping your pet exercised? (check all that apply)
 Leash walks every day Will have cable or dog run in the yard Will be free to run in a fenced yard Will have supervised access to an unfenced yard Will be free to roam around off-leash and unsupervised in an unfenced area Will be brought to a public dog park where dogs can run and play together off-leash

Other

Describe what kind of training you will provide for your pet

Potential Problems

Under what circumstances would you NOT be able to keep your new dog? (check all that apply)
 Divorce/Separation New Spouse/Partner Moving Eviction Home Foreclosure Disability/Illness Job Change/Loss Pregnancy/Baby New Roommate New Allergy New Carpet/Furniture None

Other

I would consider relinquishing my dog due to the following possible behavior problems (check all that apply)
 Kids too rough with dog Dog too rough with kids Does not get along with other pet(s) Soils inside of the house Digs/Chews/Damages property Needs too much attention/time

Other

I would need to relinquish my dog if they developed the following possible health problems (check all that apply)
 Incurs expensive vet bills Requires daily treatment Needs a special diet Becomes disabled

Other

Do you plan on taking your new dog to obedience school?
 Yes No

Have you ever been in a situation where you were not able to keep a pet?
 Yes No

If yes, please explain

Were you ever in a situation where you had to bring a dog to the shelter?
 Yes No

If yes, please explain

Do you travel often?
 Yes No

Who would take care of your pet while you were away?

Who would you give the dog to if you moved?

There are a lot of true and false statements made about Pit Bulls in the media. What are some truths that you know about the breed?

Is there any other information you feel that we should know about you?

Liability Release

Pets are an investment of your time and money. Are you prepared to provide medical care, grooming, proper diet, proper shelter and exercise for your new pet?
 Yes No

Do you understand that if arrangements don't work out with your new pet, you must be willing to return it to Josh Liddy (SwayLove.org) and that there will be no refund of your adoption fee after 5 days?
 Yes No

PLEASE NOTE: If I, Josh Liddy, ever find that you have knowingly neglected any of the basic necessities for your dog as defined by California Law, I have the right to request that you return the dog to my care. I would then reclaim both possession and ownership of the adopted dog. Also, If I find that you have been in breach of the "Liability" portion of this contract, I have the right to request that you return the dog to my care. Again, I would then reclaim both possession and ownership of the adopted dog.

By checking YES you agree to absolve Josh Liddy and SwayLove.org from any liability in reference to a dog featured within this web site.
 Yes No

By checking YES you agree that the dog will not be used in any illegal activities nor be found at any time in a municipality where Pit Bull presence is illegal.
 Yes No

By checking YES you agree that the dog is to be kept as a house pet. It shall not be sold for medical or experimental purpose, and it shall not be used for breeding or fighting nor as bait for another dog.
 Yes No

By checking YES you agree that if for whatever reason you can no longer keep the dog, you will contact Josh Liddy and make him aware of any planned transition while also giving him the option of reclaiming the dog if no appropriate plan for transition (by his definition) exists.
 Yes No

I have read the above information carefully and have filled out this application honestly. I understand that omission of information and/or failure to answer all questions can result in the application being declined. Also, if an omission or untruth is discovered after the adoption takes place, I understand and accept that Josh Liddy (SwayLove.org) has the right to annul the adoption and reclaim the dog.
 Yes No