Adoption Application Adoption Preferences In this section, please enter your adoption preferences. Filling out an application does not guarantee adoption. Remember, the more conditions you make (i.e., color, coat type, age, sex and body type), the longer it may take to find a suitable terrier to match your environment. Name of terrier you would like to adopt: Location of terrier you would like to adopt: I Don't Know 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 District of Columbia West Virginia Wisconsin Wyoming (If Known) Do you want to adopt a? ** Select ** Male Female No Preference Age Preference I am willing to consider a suitable dog of a different: Neither Different Sex Different Age Applicant Information In this section, please enter information about the person applying to adopt a terrier. Please make sure you correctly select your state as this information is used to route your application to the correct rescue representative. Applicant Name: Street Address: City: State: Pick 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 District of Columbia West Virginia Wisconsin Wyoming Zip: Email: Home Phone: Work Phone: When is the best time to call? Occupation: When could you take possession of a dog? How far would you travel to pick up the terrier? Housing/Landlord Information Do you own or rent your home? Own Rent I (we) live in a: ** Select ** House Apartment Trailer Other If "Other": Do you have your landlord's permission to own a dog? Yes No Landlord Name: Landlord Phone: How long have you lived at this address? Fence/Yard/Kennel Information Do you have a completely fenced yard suitable for a dog? Yes No Do you have a kennel run? Yes No Describe fence and/or kennel run (type, height, size): If no fence/kennel, how will you handlethe dog's exercise/toilet needs? Do you have a suitable dog crate? Yes No Household Information How many Adults in the household? 1 2 3+ How many Children in the household? None 1 2 3+ Are you planning to have kids within the next 5 years? Yes No Age of adults? Age and gender of children? Any household members allergic to animals? Yes No How many hours a day must terrier be alone? Are there visitors to your home with which a new dog will have to interact? Yes No How would you describe your lifestyle? ** Select Lifestyle ** Very Active Active Passive Other Animal Information Do you own any other dogs? Yes No If yes, are they Spay/Neutered? N/A Yes No Please list breed, size, and gender of each: Do you own any cats? No Yes If yes, how many? None 1 2 3+ Do you own any other animals? No Yes If yes, describe: How many dogs have you owned in the past 5 years? If you do not still own the dog(s), what happened to them? Breed Specific Information Have you ever owned a JRT before? Yes No Why did you choose this breed? What is the JRT is bred to do? What activities do you plan with this dog? Pet Guard Hunting Obedience Terrier Trials Other Where do you intend to keep this dog primarily? Indoors Outdoors Where will the dog sleep? Veterinarian Information Do you have a regular veterinarian? Yes No If NO, skip section Vet Clinic Name: Doctor Name: Street Address: City: State: Zip: Vet Phone #: Date of Last Vet Visit: Reference/Miscellaneous Information How did you learn about us? ** Select ** Russell Rescue, Inc. Web Site JRTCA Web Site JRTCA Breeders Web Site True Grit Magazine From a Friend From a Breeder From my Vet Other If "Other": Personal Reference (Name, Relationship, Phone): Comments: Username If you do not receive a notice that tells you the application was submitted,please Contact Us. By submitting this application, you are making a FORMAL request to adopt a dog from Russell Rescue, Inc., an all-volunteer, donation-supported organization. Please do not fill out this application if you are not serious about working with Russell Rescue, Inc. You will be contacted if a suitable terrier is matched to your application. Filling out an application does not guarantee a terrier. Not all homes are suitable for placement. Russell Rescue, Inc. has the right to refuse any application.