Adoption Form Please fill out this form completely and truthfully and to the best of your ability. There is a Save And Continue Later link at the end of this form. We only accept applications in British Columbia.Application Contact InformationApplicant Name* First Last Applicant Age* Co-Applicant Name First Last Co-Applicant Age Applicant Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Home Phone*Cell PhoneApplicant Email Address* Employment InformationApplicant Occupation* Applicant Employer* Applicant Employer Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Applicant Employer Phone*Applicant - Duration of employment* Co-Applicant Occupation Co-Applicant Employer Co-Applicant Employer Address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Co-Applicant Employer PhoneCo-Applicant - Duration of employment Household Member Information* List all household members other than the Applications: (Name, Age, and Relationship)Do children visit your home?* Yes No How often?* Are you willing to supervise the dog at all times with children under the age of 10 years?* Yes No Who will be responsible for caring for the bulldog?* Is anyone in the household allergic to dogs?* Yes No Are all members of the household in favor of adopting a Bulldog?* Yes No Application ExpectationsWhy do you want to adopt a bulldog?*What age bulldog are you willing to adopt?*0 to 1 year1 to 3 years3 to 6 years6 to 8 years8 and olderAny age, including seniorHospiceWhat gender are you willing to adopt?*MaleFemaleEitherMust the bulldog be good with children?* Yes No Explain Must the bulldog get along with dogs in your home and/or with visiting dogs?* Yes No Are you willing to accept a bulldog needing additional care?* Yes No If yes, which level of care are you comfortable providing?*Note: Every bulldog requires daily care, more than other breeds. Daily medications, special foods, etc. Frequent medications, house training issues, difficulty walking, behaviour issues Blindness, deafness, incontinence, spina bifida, seizure disorders etc. Dwelling InformationType of Home*HouseApartmentCondoTownhouseMobile HomeOtherIf Other, please describe*Ownership* Own Rent Lease How long?*How long have you lived in your current location? Landlord contact information*If you are renting or, please provide your landlords name and phone number. This information is mandatory as we will contact your landlord to verify that you are allowed to have a dog. Do you have a fully fenced yard?* Yes No Fence type Fence Height* How will the dog be exercised*How will the dog be exercised, how often, and who will supervise the dog while outdoors?Stairs?*Does your home have stairs that the Bulldog will have to go up and down? Yes No Describe the stairs* Body of water?*Do you have a swimming pool, pond, including ornamental ponds, In-ground hot tub, lake, river or any other body of water in or near your residence? Yes No Fenced?*Is there a secure fence to keep the Bulldog out? Yes No Describe the fence* Where will the Bulldog be kept during the DAY?* Where will the Bulldog be kept during the NIGHT?* Lifestyle and Household InformationWhat five words describe your family?* Please describe any changes you expect in your household*Please describe any changes you expect in your household in the next few years: (New children, job changes, moving etc.)How soon will you be ready to adopt a bulldog?*ImmediatelyIn the next 3 monthsIn the next 6 months6 months or more How much daily exercise can you give your dog on weekdays?* How much daily exercise can you give your dog on weekends?* Are any family members at home during the day time?*AllMost of the DaySometimesSeldomDaily hours dog is alone?* Explain care plan if not home all day.*Are you involved in a pet store, commercial dog operation or buying dogs for resale, or dog training?* Yes No Have you ever been convicted of cruelty to animals?* Yes No Other pet information (Current and Past)Have you ever owned a Bulldog?* Yes No For how long?* Do you currently own dogs?* Yes No How many Dogs?* Are the dogs spayed or neutered?* Yes No Do you currently own cats?* Yes No How many cats?* Please list ALL animals that live in your home now or have lived in your household in the past 5 years (Type/Breed, Age, Gender, Spayed/Neutered. Where is it now?)*Have you ever given up your pet to a rescue organization or animal shelter or rescue?* Yes No Describe the circumstance.*Have you ever had a dog that has bitten someone?* Yes No Do all your current pets get along well with other animals?* Yes No Please explain.*Do all your pets receive regular veterinary care and are they up-to-date on vaccinations?* Yes No If you have adopted a rescue before provide details.Pet Care PhilosophyWhat type of behaviours in a dog would make you NOT want to adopt him or her?*Check any that you would NOT want.* Separation Anxiety Excitability Mild Aggression Barking Obedience House Training Vocalizing Fearfulness Other If other, please explain.* Explain how you will correct behaviour problems?*Do you understand that rescued dogs may have house-training problems, especially at first?* Yes No Are you familiar with common Bulldog health problems and maintenance?* Yes No How much do you expect to pay PER YEAR to take care of a bulldog’s medical care?* How much do you expect to pay PER YEAR to take care of a bulldog over all?* Who will care for the Bulldog during vacations or overnight trips?* Can someone in the household provide daily care when the primary caregiver is away?* Yes No Who* Do you have an emergency plan to provide care for your pets if you have to leave town suddenly?* Yes No Describe your plan*Under what conditions would you return your dog?*Select all that apply. Moving Too Costly New Baby Sick Dog Not Enough Time Aggression Divorce/Separation Behavioural Problems Other Other: Please List and Explain.*ReferencesList two people who are NOT in your household, who can verify your ability to take good care of a rescued bulldog.*Name, phone number and relationship to you. (They will only be contacted on approved applications)Current Vet InformationDo you currently have a Vet?* Yes No Veterinarian Clinic Name* Veterinarian Name* Veterinarian Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Vet Phone Number*Vet Email Address* Have you asked about their experiences with Bulldogs?* Yes No Describe what they said*Agreements/UnderstandingsCan all household members travel to meet the prospective adoptee?* Yes No Are you willing to take responsibility for the Bulldog for its lifetime?* Yes No Do you agree to have a rescue volunteer inspect your home before and/or after an adoption is complete?* Yes No Do you agree to return the bulldog to Melanie at Victoria Bulldog Society for any reason you can’t keep the bulldog?* Yes No All dogs adopted from Victoria Bulldog Society will be spayed or neutered prior to placement. Do you have questions or reservations about this requirement?* Yes No Explain your reservations.*Why would you be a good adopter?*We will keep applications on file for 2 years but please contact us for each bulldog you are interested in.