SSRR provides services in the following areas only: Northern Florida (north of Orlando), Georgia, Alabama, North and South Carolina, the Virginia Peninsula, Tennessee, Mississippi, Louisiana, Texas and Arkansas.  If you are located elsewhere, please visit our links page to find a Rottweiler Rescue organization in your area.
 

This questionnaire is intended to be a guide to help you think about all the ways a Rottweiler will impact your life and also to determine if a Rottweiler is the right breed for you.  All of the questions concern various aspects of dog ownership that should be given serious consideration before deciding to share your life with any dog.  The information you provide on this application will help us to find the most suitable dog for your family. 

Please Note:  Asterisks denote mandatory fields.  The form will not submit without them.  Please complete entire application and place n/a in fields that do not apply.

Personal Information:
 

Name: *   Age: *
Spouse/Significant Other Name:   Age:
Address: *  City: *  State: *  Zip: * 
Email Address: *  (Without a valid Email address, we can not reply to your request.  Please ensure accuracy.)
Home Phone Number: * 

Your Employer:   Work Phone:   Hours at work:

Spouse/Significant Other's Employer:   Work Phone:   Hours at work:


Children living at home:

Name: Age:
Name: Age:
Name: Age:
Name: Age:
Name: Age:

If you do not have children, do you plan to have children some day? Yes No
If yes, explain how this will affect the dog's place in the household:


Does anyone else live in your home? Yes No

Name: Relationship: Age:
Name: Relationship: Age:
Name: Relationship: Age:

Does anyone in your home have allergies or asthma: Yes No

Your Residence:

Which of the following best describes your living situation:

House Condo Mobile Home Apartment Other

Type of environment: City Suburbs Country

Do you: Own Rent Live with Parents

If you rent, please provide the following:
Landlord's Name:   Landlord's Phone Number:

Renters must provide landlord statement indicating that a Rottweiler may live on the premises.

How long have you lived at this address?

If less than 2 years, previous address and landlord:

Name of Homeowner Insurance company:  *

Insurance Agent Name:  * Telephone Number:  *

Do you have a fenced yard? * Yes No

Type and height of fence: * Is the gate padlocked? Yes No

Do you have a pool? Yes No Is it fenced separately? Yes No

What is the maximum number of dogs/pets allowed by city ordinance?

What are your local licensing fees/requirements?

Is there a chance you might move in the next 10 years? Yes No

If so, are you willing to restrict your choice of housing to places where a Rottweiler is allowed? Yes No

Care and Responsibility:

Is there a particular dog on our website that you are interested in? Yes No

Name:

What steps have you taken to learn about Rottweilers and dog ownership? 

Have you ever owned a Rottweiler? Yes No

Do you prefer a male or female Rottweiler? Male Female
Why?

Age range: Puppy Teen Young Adult Adult Mature Any

Will you accept a Rottweiler with special medical needs? Yes No

Will the Rottweiler serve as a guard dog? Yes No

Where will the dog be kept? Inside Outside Other (specify):

Where will the dog sleep at night?

How many hours per day will the dog be left alone?

Do you own a dog crate? Yes No

If no, are you willing to purchase one? Yes No

Will you take your dog to obedience class? Yes No (explain)

What types of activities will your Rottweiler participate in?


What types of behavioral/training issues are you prepared to deal with?

Chewing Yes No

Housebreaking Yes No

Barking/Whining Yes No

Marking Yes No

Leash Pulling Yes No

Nipping/Mouthing Yes No

Food Aggression Yes No

Pack Dominance Yes No

Chasing Cats Yes No

Digging Yes No

Jumping on People Yes No

Resource Guarding Yes No
Do you understand that the dog will take time to adjust to its new surroundings and that certain behavioral issues might occur? Yes No
Are you willing to work with SSRR to correct these issues? Yes No
Under what circumstances might you want to return your dog? (Examples: Marriage, new baby, divorce, behavior issues, financial stress, moving, job change, etc.)

History of Pet Ownership:

Do you currently have other pets? Yes No

If yes, please describe each pet in detail (species, age, breed, sex, spayed/neutered, personality):

If you currently have a dog or dogs, what is the extent of their obedience training? If you have never had Basic Dog Obedience Training for a large breed dog, SSRR will assist you in finding an approved course. It is mandatory that within 30 days of adoption that a Structured Basic Dog Obedience Course be scheduled.
The class must be completed within the first 90 days of the of the adoption. All dogs under the age of 1 year old are required to take Basic Obedience Training. Certificate of Completion of "Obedience Class" will need to be sent to SSRR.

Veterinarian Name: * Veterinarian Phone: *

Names of animals seen at that vet clinic:

Are your pets current on vaccinations? Yes No

Are your dogs on heartworm preventive medication? Yes No
Brand    If no, why not?

If you have pets that are not spayed or neutered, please explain why:

Have you ever had a pet hit by a car? Yes No

Please list all the animals you have owned in the past 10 years and what happened to them:

What do you enjoy most about dog ownership?

What do you like least about dog ownership? 

List any Humane Societies, Kennel Clubs, Breed or Training Clubs you are associated with:

References:

Please list the names and telephone numbers of 3 references not related to you. If you do not currently have pets under vet care, please provide a 4th reference.

Name: * Phone Number:  *
Name: * Phone Number:  *
Name: * Phone Number:  *
Name: * Phone Number:  *
 

How did you learn about SSRR?
 

By signing below, Applicant certifies that the above information is true and understands that, prior to being approved for adoption, this information will be verified.  A home visit will be scheduled and all members of the household must be present.  Applicant certifies that he/she is financially and physically able to care for the animal.  Applicant understands that proper food and vet care can be costly and is prepared to meet these requirements.  The adopted Rottweiler will be spayed/neutered, current on vaccinations and on heartworm preventive medication prior to placement.  Approved adoptions require a signed Adoption Contract.  Adopter will also make a tax-deductible donation of $250 to SSRR upon taking possession of the dog.  SSRR reserves the right to make random visits to ensure the adopted dog is being properly cared for, and if it is not, to remove the dog from the premises without refund.

SSRR reserves the right to decline any application.

 

"I/we hereby state that neither I/we nor anyone in my/our household, nor anyone who will have access to or care for this dog, has ever been charged with or convicted of any offense involving animal neglect, abuse, or cruelty, regardless of any dismissal or deferred prosecution or other expunging of the records. I/we understand and agree that if this statement is found to be incorrect, without further evidence of any other contract violation, the Rescue may immediately obtain return of all animals adopted to me/us, without refund of any sums paid, donated, or expenses incurred. Further, it is agreed that I/we shall pay all costs of the recovery and return of said dog(s) incurred by said Rescue."
 

Signature: *  Confirm email address: