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: (If Known)
Do you want to adopt a?
Age Preference
I am willing to consider a suitable dog of a different:

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:
State:   Zip:
Home Phone:
Work Phone:
When is the best time to call?
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:
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 handle
the dog's exercise/toilet needs?
Do you have a suitable dog crate? Yes   No

Household Information

How many Adults in the household?
How many Children in the household?
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?

Other Animal Information

Do you own any other dogs? Yes   No
If yes, are they Spay/Neutered?
Please list breed, size, and gender of each:
Do you own any cats?    If yes, how many?
Do you own any other animals?   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?
Where do you intend to keep this dog primarily? Indoors
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:
State:   Zip:
Vet Phone #:
Date of Last Vet Visit:

Reference/Miscellaneous Information

How did you learn about us?
If "Other":
Personal Reference (Name, Relationship, Phone):

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.