In order for this form to submit properly, you MUST answer the 8 REQUIRED questions, designated by the asterisk (*).

Name(s) of dogs you are interested in:
Date: Interview By:
*Applicant: *Age:
Spouse's Name: Age:
*Address:
*City: *State:
*Zip: County:
*Home Phone: *Work Phone:
Cell: Email:
Employer:
How many hours a week do you work?

Please answer ALL of the following questions in order for NoVa to properly process your application.

Please provide the names & ages of all children living with you: 
Who beside immediate family and/or children, reside with you? Please name them, list their relationship & ages:
Are you seeking other avenues to attain a dog such as other rescues or facilities?
If so, please explain, and give the name and phone number of that organization:
Is there a certain available dog you are interested in adopting? If so, who?
If yes, and he/she is no longer available, would you be interested in another dog? If so, who?
Would a male or female Rottweiler fit better in your home?
What age range would you consider?
Would you consider a Rottie with its natural full tail instead of the standard "docked" tail?
Is there any other criteria you have for the dog you would like to adopt? If yes, please describe:

Please answer ALL of the following questions regarding your home:

Are you a homeowner?
If you are a homeowner, is YOUR name on the mortgage payment book?
Do you rent your home?
If you rent your home, please provide the name & phone number of your landlord:
What type of home do you live in?
How long have you lived at your current address?
If you have lived at your current address for less than 2 years, please provide your previous address and/or landlord information:
Do you know the city animal ordinances/licensing procedures in your area?
Do you have a city or county ordinance that limits the number of dogs you are allowed to have in your home?
If yes, what is the maximum number of dogs you are permitted to have?
Do you have a fenced yard?
If yes, please accurately describe what type of fence you have and how high:
Is the fence secured under ground as well?
If you do not have a fence do you plan on putting one up?
If you do not have a fenced yard, please explain how you will allow for the dog to defecate/urinate?
Do you currently keep the gates padlocked?
Do you have a pool?
If yes, is your pool fenced seperately?
Do you have a homeowners or renters insurance policy?
If yes, what is the name of the insurance company?

Please answer ALL of the following questions regarding the environment for your new adoptive pet:

Where will the dog be kept when you are not at home?

Please describe where and how the dog will live on a typical day:

Is someone home during the day? If yes, who?
How many hours per day will the dog be left alone and/or crated?
Do you have a crate?
If so, what type and size is the crate?
If no, are you willing to purchase a crate if needed?

Please answer ALL of the following questions regarding your personal pet experiences:

Do you now, or have you ever owned any other pets before?
If yes, please describe the pets in detail and give names and ages of all pets:
If you currently have a pet, is he/she and only pet?
If yes, how long has he/she been alone?
If you own or have owned a dog or cat, is/was it spayed/neutered and current on all vaccinations?
If Not, please explain why:
Are your dogs or cats currently on heartworm preventative?
What type?
If you do not/did not give your dogs heartworm preventative please explain why:
If applicable, please give the approximate date of your pet's last vet visit:
If there were previous pets, please describe what happened to them:
Have you ever given any of your pets away or surrendered them to anyone?
If so, please give the name and phone number of the person to whom you surrendered the pet:
Have you ever owned a Rottweiler?
If yes, please give the names and ages and explain why they are no longer with you:
Do you belong to any kennel clubs, obedience clubs, or other dog-related clubs?
If yes, please describe:
Please explain why you wish to adopt a Rottweiler:
What steps have you taken to learn about this breed and/or dog ownership?

We will attempt to provide you with an honest evaluation of temperment on any dog we adopt to you. Do you realize that often times a complete history of a Rottweiler may not be known and you may encounter some behavioral problems?

Are you willing to work with & correct these problems if you encounter them?
Are you willing to take the adopted dog to obedience classes?
Why or why not?
What behavioral/training issues 'can' you deal with?
What behavioral/training issues can you 'not' deal with?
If you were to return this (or any) dog, for what reason would it be?
What length of time do you feel is adequate to allow an adopted dog to adjust to your home?
What length of time are you willing to give a dog to adjust to your home?

How did you hear about Northern Virginia Rottweiler Rescue?

Please list the names of your current Veterinarian(s), the name of animal hospitals you have used, their address and phone numbers (if you have changed Vets in the last year, please also list the previous Vet):

Name:      Phone:

Address:

Name:      Phone:

Address:

Are you willing to sign a legal adoption contract?

PLEASE BE ADVISED THAT SIGNING A LEGAL ADOPTION CONTRACT MEANS THAT YOU ARE OBLIGATED TO ALL THE TERMS OF THE CONTRACT OR THE DOG MUST BE RETURNED TO NOVA ROTTWEILER RESCUE, OR THE DOG WILL BE REDEEMED THROUGH A CLAIM AND DELIVERY SERVICE.

Please list three (NON-RELATIVE) references including their name, address, and telephone number:

1. Name:       Phone:

Address: 

2. Name:       Phone:

Address: 

3. Name:       Phone:

Address: 

I certify that the above information is true and I understand that prior to being approved for adoption, the above information will be verified. In all cases, a home visit will be required. I also agree to a personal interview with a member of NoVa Rottweiler Rescue, if required, to determine the suitability of my home to care for a canine. I understand and agree that falsification of any of the above information is grounds to disqualify my adoption application and nullify all adoption(s) and/or adoption agreements between the appliant and NoVa Rottweiler Rescue. I understand my electronic signature is legal and binding. I authorize NVRRL to obtain any information needed from all above references.

Please type your electronic signature here:

Date:

Please review your answers.  When you are ready to send your application to NoVa Rottweiler Rescue, please hit the SUBMIT button below.  Thank you for taking the time to apply for our beautiful dogs!