Ramapo-Bergen Animal Refuge, Inc
The leading, no-kill animal shelter in Bergen County

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Online Dog Adoption Application

R.B.A.R.I.
Ramapo Bergen Animal Refuge, Inc.
STAFF:_______ DATE:______

CANINE MATCHMAKING QUESTIONNAIRE

FEES: Puppies (10 months & younger) $250-$300 Dogs (11 months & older) $175 Pure Breeds $300 +

*At the time of adoption adopters are required to bring a 6 ft. leash (No retractable leashes). Leashes may purchased from RBARI for $5.00*

Name of Dog Looking to Adopt (If Known)

Name *

Street Address *

City,State,Zip *

Home Phone *

Work or Cell Phone *

Email Address *

Age *

How did you hear about us? *

Who is the pet for? *

How many people live in the home? *

# of Adults over 18 *

# of Children under 18 *

Names & Ages of everyone in the home *

Anyone in the home have allergies or a breathing condition affected by a pet? * Yes No Unsure

If Yes, who?

Do you * Own a home? Rent a house or apartment Live with Parents Other

Is your home: * Single Family House Two Family House Apartment Townhouse/Condo Other

Does your lease or complex allow pets? *YesNoUnsure

Landlords Name

Phone Number

Do you have a yard? *YesNo

If Yes, is it fenced? *YesNo

Type of Fence:

Height:

If no where will you exercise your new dog or puppy?

Are you planning on moving in the near future? *YesNo

Estimated Move Date:

Are you prepared/willing to find only pet friendly housing? *YesNo

Do you work? *YesNo

If yes what hours?

Employer:

Does your housemate(s) work? *YesNo

If yes what hours?

Employer:

Who will be the main caretaker of the pet? *SelfSpouseChildrenOther

If Other please list:

How many hours will this pet be alone during the day?

Where will this pet be kept during the day?

At night:

How many hours a day will the dog be inside?

Outside?

When outside will the dog be:Tied OutsideIn Fenced yardIn a Dog RunOther

If Other please list:

In brief what are your methods for housebreaking and obedience training your pet?

Are you willing to crate train?YesNoUnsure

Are you willing to work through behavioral issues that may arise?YesNo

Are you willing to go through professioanl obedience training with your new pet if needed?YesNo

Are you aware/willing tp pay yearly vet bills and other pet related expenses that can amount to over $500 per year?YesNo

If No please explain:

Are you going to spay/neuter your new pet?YesNo

If No please explain:

Name of Veterinarian:

Phone:

Would there be any reason for giving up your own pet?

Should you no longer be able to care for your pet, do you have an alternate plan for your pet?YesNoUnsure

If yes, what is plan?

If Other please list:

Have you ever owned pets in the past? Yes No Family/Grew up with

If yes, what kind of pets:

Where did you get them from? Breeder Shelter/Rescue Pet Store Gift Other

If Other please list:

How many pets have you owned in the last five years?

Number of Dogs?

Number of Cats?

What happened to them?

If Other please list:

If they died, from what and how old?

Have you ever given up a pet for any reason? Yes No

If Yes, Why?

How many pets are living at the above address?

Dogs (Please List):

Name

Age

Neutered Yes No

Up to date on all shots? Yes No

Name

Age

Neutered Yes No

Up to date on all shots? Yes No

Cats (Please List):

Name

Age

Neutered Yes No

Up to date on all shots? Yes No

Name

Age

Neutered Yes No

Up to date on all shots? Yes No

Other Pets

Answers to the following questions will help us match an appropriate pet, best suited to your interests and lifestyle. Please tell us about your ideal pet: House Pet Outside Pet Pet for Breeding Pet for Business Watch Dog Gift - For Who:

Gift - for who?

Desired Breeds:

Sex Male Female Doesn't Matter

Age Range Adult/Over 12 months Puppy 2-4 months 4-8 months 8-12 months Senior

Size Toy 3-10 lbs Small 5-20 lbs Medium 20-50 lbs Large 50-80 lbs X-Large 80+ lbs

Please check all that apply: Housebroken Obedience Trained Non-Shedding Calm Energetic & Likes to Play Smart Outgoing Lap Dog Dog Friendly Cat Friendly Child Friendly

Are you willing to adopt a Special Needs Pet? Yes No Possibly

I sign here to signify that all of the above information is true and correct to the best of my knowledge. By signing this I also give permission to the Ramapo-Bergen Animal Refuge, Inc. to check my vet references for any vet listed or vet that I have used in the past.

Potential Adopter Signature (Type Full Name)

Please type the letters and numbers shown in the image.

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Online Dog Adoption Application

ADOPTION HOURS

Tuesday & Thursday:
1pm - 8pm

Wednesday:
12pm - 4pm

Saturday & Sunday:
11am - 4pm

CONTACT INFO

RBARI:
2 Shelter Lane
Oakland, NJ 07436
Click Here for Map & Directions
Phone: 201-337-5180
Fax: 201-337-2040
Email: [email protected]

DOWNLOAD FORMS

Matchmaking Form Cats
Matchmaking Form Dogs
Volunteer Application Jr (14-15)
Volunteer Application
Foster Application
Fund a Friend

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