Your First Name
Your Last Name
Are you interested in a service dog?
Are you any of the following?
To conduct a background check, what is your Date of Birth? **REMAINS CONFIDENTIAL**
What are the last 4 digits of your social security number? **REMAINS CONFIDENTIAL**
What is the address where your animal will live?
Which animal are you interested in adopting?
What type of bully breed dog are you looking to adopt?
Alapaha Blue Blood Bulldog
American Bulldog - Johnson
American Bulldog - Scott
American Bully Dog - Classic
American Bully Dog - Extreme
American Bully Dog - Pocket
American Bully Dog - XL
American Pit Bull Terrier
American Staffordshire Terrier
Ca De Bou
Cane Corso Italiano
Cane Corso Mastiff
Dogue De Bordeaux
Dorset Olde Tyme Bulldogge
Miniature Bull Terrier
Old Boston Bulldogge
Old English Bulldog
Staffordshire Bull Terrier
Standard Bull Terrier
List the names, ages, relation, and animal related allergies of all people living in the household.
What type of home do you live in?
Check all that apply.
Live with Parent
Live with Roommate
If you live with someone will they allow a pet?
If you rent are bully breed pets allowed?
If you rent, please list the name, contact number, and email for property manager.
How long have you lived at your current residence?
How many times have you moved in the last 3 years? Please explain reasons for moving.
What type of fence do you have at your home?
How high is your fence and can the dog get over or under the fence?
Where will your dog live?
Do you own other animals?
List each animal in the home including name, sex, age, and breed.
Are any of your pets not spayed/neutered? Please explain why if they are not.
Are any of your pets behind on their vaccinations? Please explain if they are not current.
Have any of your pets ever died from the following diseases?
If a pet died of any of the aforementioned diseases, were the grounds the animal lived on disinfected to ensure the disease is eradicated?
Have you rehomed an animal in the last year and if so, where is the animal now?
Are your pets on flea/tick and heartworm prevention?
Please list the name, contact number, and email address of 2 personal references and your veterinarian.
Is this the first animal you have ever rescued?
If you were to relocate will the adopted pet stay with you?
Are you financially able to care for your animals including food, shelter, heartworm prevention, flea/tick/parasite prevention, routine vet care, yearly vaccinations and rabies shot, and emergency medical care?
How many hours a day will your pet be left alone?
How will your animal be cared for when you are out of town?
Please list the name, contact number, and email address of your regular pet sitter.
Who will be the primary care giver for your pet?
Who are you adopting for and what is your reason for adopting? (Check all that apply.)
PTSD Service Dog
How will you house train your dog?
How many hours will your dog be crated?
How will you handle normal dog behavior such as chewing, scratching, barking, whining, or other stress-related behavior?
Would you like information on behavior training?
Will your dog need to be tied up and If so will the dog be tied up overnight, for how long, and what will the dog be tied to?
What type of animal/person socialization will your dog receive and how often will they be socialized?
Will you permit Rebel Rescue to inspect your pet's new home at any time before and after adoption?
Review Our Terms & Conditions of Adoption
TERMS AND CONDITIONS OF ADOPTION
A copy of these terms and conditions is available on the Rebel Rescue website. Animal Adoption Conditions
Rebel Rescue accepts no responsibility as to description, condition, temperament, behavior or health of the Animal and provides no warranty, condition, representation or other term of any kind expressed or implied other than such warranties, conditions, representations and terms to the extent to which they cannot be legally excluded (whether in accordance with any legislation amending or replacing the same, or otherwise).
Any information concerning the habits and past history of the Animal is passed on by Rebel Rescue to the Adopter in good faith. This is based on statements made by the previous owner and the person who found the Animal; however, there is no guarantee of reliability. Rebel Rescue is unable, therefore, to accept liability for any consequences whatsoever resulting from events attributable to the failure to give information or the transmission of wrong information provided that nothing in these conditions excludes Rebel Rescue's liability for fraud.
The Adopter confirms that no person residing in their household, is disqualified from keeping animals or has had a deprivation order made under the Animal Welfare Act and/or has an unspent conviction for offences relating to animals.
The Animal is believed to be in normal health on leaving the animal establishment except where specific conditions have been made known to the Adopter in writing. Subject to Condition 1, it is regretted that Rebel Rescue is unable to accept liability for any expenses or costs of any kind arising from sickness or injury of any nature developed by the Animal (whether or not any known existing conditions or symptoms of the Animal are made known to the Adopter prior to this Agreement) and the responsibility for and cost of future treatment shall be incurred by the Adopter.
Attention is drawn to the possible liability of the Adopter for damage and injury which they may cause to third parties or their property. In particular, liability may arise or there is a possibility of an action for nuisance against the Adopter as a result of the Animal's behavior should also be recognized.
Rebel Rescue strongly advises the Adopter to arrange appropriate insurance coverage against risks referred to in this Agreement and also the costs of veterinary treatment.
The Adopter agrees to comply with all relevant regulations, legislation and laws concerning the welfare, control, responsible ownership and protection of animals including, without limitation, the Animal Welfare Act.
Rebel Rescue will NOT adopt an animal that has not been wormed, spayed/neutered, given their rabies vaccination, micro-chipped, given their DHLPPC vaccination(s), and heart worm checked (if older than 6 months).
The Adopter agrees to meet the welfare needs of the animal. This means providing for the animal's health, happiness and welfare needs by taking measures to ensure that the animal's health is maintained, it is properly housed, fed, watered, socialized, exercised, and receives appropriate veterinary care, including vaccination, heart worm preventative, regular worming and flea treatment, as appropriate to the species. This also includes picking up your animal from any shelter facility within 72 hours if they get picked up by a City, County, or other rescue. If the adopted animal is not reclaimed within 72 hours, Rebel Rescue will reclaim the animal as its guardian and you will have to petition for the animal's return to your care. Reclaiming the animal from Rebel Rescue means you may be required to pass another home check and pay for boarding fees while Rebel Rescue cared for your animal in your absence. Rebel Rescue reserves the right to not return the animal if a pattern of irresponsible pet ownership and at-large animal behavior exists. This also means that you MUST maintain flea and parasite preventative treatment on a monthly basis. Ask us about the products that will suit your pet if you are unsure what to give them. Lastly, it is in the best welfare of all animals to only be tethered in accordance to Texas Health and Safety Code Sec. 821.077. UNLAWFUL RESTRAINT OF DOG. An owner may not leave a dog outside and unattended by use of a restraint that unreasonably limits the dog's movement: between the hours of 10 p.m. and 6 a.m.; within 500 feet of the premises of a school; or in the case of extreme weather conditions, including conditions in which: the actual or effective outdoor temperature is below 32 degrees Fahrenheit; a heat advisory has been issued by a local or state authority or jurisdiction; or a hurricane, tropical storm, or tornado warning has been issued for the jurisdiction by the National Weather Service. Please do NOT use heavy chains to tether your animals because this is inhumane and will constitute irresponsible ownership on the Adopter's part.
The Adopter agrees to maintain the microchip records of the animal, by informing the microchip database of any changes of address or ownership of the animal. Rebel Rescue uses Datamars Guardian chips which mean our rescue remains on the registration in addition to the Adopter. Rebel Rescue will ALWAYS be notified when your pet is found. Contact Datamars to register your Pet Link information at https://www.petlink.net/.
The Adopter agrees not to sell or part with the animal. If at some point the animal must be re-homed, the Adopter MUST return the animal to Rebel Rescue. If a former Rebel Rescue animal is found to have been re-homed, Rebel Rescue will confiscate the animal based on your understanding and authorization that is clearly defined by this contract. However, if you have a new Adopter in mind, please communicate their contact information when you return the animal and we will contact them to make the adoption. They will have to pass a background check and home visit, but we will offer a reduced price adoption. Please understand that this is in the best interest and for the protection of the bully breed animals. Protecting our bully breed rescue's interest and welfare is our only mission.
Subject to conditions 1 and 13, Rebel Rescue's maximum liability under or in connection with this Agreement shall not exceed the Fee paid by the Adopter for the animal.
Nothing in this Agreement shall exclude or in any way limit Rebel Rescue's liability for fraud, or for the death or personal injury caused by its negligence or any other liability or consumer right which it cannot legally exclude or limit.
If any provision of this Agreement is found to be unenforceable, it shall so far as it is unenforceable, be deemed deleted and the remaining provisions of this Agreement shall continue to apply.
The American Courts will have exclusive jurisdiction over any claim arising from or related to this Agreement. American law will apply to this Agreement.
I agree to the terms and conditions of adoption stated herein.
ADOPTION DECLARATION I, the Adopter, am over 18 years of age and accept the terms and conditions contained on the reverse of this agreement and available at www.rebelrescuetx.org. I also further agree that:
I have not been disqualified from owning or keeping animals or had a deprivation order made under the Animal Welfare Act and/or have an unspent conviction for offences relating to animals.
I will not irresponsibly sell or part with the Animal.
Rebel Rescue staff can visit the Animal post-adoption to ensure that the adoption has been successful.
I will be a responsible pet owner and ensure that the Animal has a happy and healthy life.
I will ensure this animal is given love, shelter, food, protected in extreme cold/hot conditions, medical care, and will only be tethered in accordance with the Texas Health and Safety Code Sec. 821.077. UNLAWFUL RESTRAINT OF DOG. An owner may not leave a dog outside and unattended by use of a restraint that unreasonably limits the dog's movement: between the hours of 10 p.m. and 6 a.m.; within 500 feet of the premises of a school; or in the case of extreme weather conditions, including conditions in which: the actual or effective outdoor temperature is below 32 degrees Fahrenheit; a heat advisory has been issued by a local or state authority or jurisdiction; or a hurricane, tropical storm, or tornado warning has been issued for the jurisdiction by the National Weather Service.
All dogs in my household have been spayed or neutered.
Our goal is to place animals into permanent, caring, and loving homes. We will do what is best for the animal being considered for adoption. Some need country homes, some need adult-only homes, and some need homes where they will not be left alone for long periods of time. Some need single dog homes. Please understand that if you are refused, it is because it is in the best interest of the animal. We reserve the right to hold an application for as long as needed before adopting out an animal so that we may review it, check references and conduct a home check to allow adoption.
Rebel Rescue wants you to be happy with the pet you want to adopt. We will provide you with all the information, both medically and behaviorally, that we have collected on the pet. Please understand that animals, by their nature, may react differently in different situations and environments. We ask that you give your pet a fair chance, at least one week, to adapt to their new family and surroundings if they are adopted. Adapting to their new family usually includes structured and controlled introductions to family members, friends, and other pets. The adoptive pet will have had a veterinarian examination, vaccinations, been heart worm tested if old enough, spayed/neutered, and micro-chipped.
I will permit Rebel Rescue to inspect my pet's new home when requested and authorize Rebel Rescue to remove my pet from my custody if the animal is found to be receiving inadequate care, abused, neglected, improperly housed or handled, or if there is evidence that any of the provisions of this contract are being violated. I MUST provide shelter, food, water, and I CANNOT tether my animal outside the practices of the Texas Health and Safety Code Sec. 821.077. UNLAWFUL RESTRAINT OF DOG. An owner may not leave a dog outside and unattended by use of a restraint that unreasonably limits the dog's movement: between the hours of 10 p.m. and 6 a.m.; within 500 feet of the premises of a school; or in the case of extreme weather conditions, including conditions in which: the actual or effective outdoor temperature is below 32 degrees Fahrenheit; a heat advisory has been issued by a local or state authority or jurisdiction; or a hurricane, tropical storm, or tornado warning has been issued for the jurisdiction by the National Weather Service. Adequate care includes picking up my animal from any shelter facility within 72 hours if my animal gets picked up by a City, County, or rescue group. If my animal is not reclaimed within 72 hours, Rebel Rescue will reclaim my animal as its guardian and I will have to petition for my animal's return to my care. Reclaiming my animal from Rebel Rescue means I may be required to pass another home check and pay for boarding fees while Rebel Rescue cared for my animal in my absence. Rebel Rescue reserves the right to not return the animal if a pattern of irresponsible pet ownership and at-large animal behavior exists. If my pet is reclaimed, I understand that Rebel Rescue will not be obligated to refund the adoption fee or any other expenses incurred by this adoption. Rebel Rescue also reserves the right to prohibit the adoption of more than one of their rescue dogs to the same household or one of their dogs to a household with more than one dog already. I understand this is for the dog's protection and well-being.
Upon signing our adoption contract, I agree to accept responsibility for future vaccinations and continued veterinary care of this pet, and I understand that Rebel Rescue will not be able to provide further financial assistance with diagnosis or treatment of this pet. I hereby release and discharge Rebel Rescue forever from liability for any injury or damages to any person, animal, or property caused in the future by this pet and from any causes of action, claims, suits, or demands whatsoever that may arise as a result of such injury or damages. I also understand that if I am no longer able to care for the animal I adopted, I will return the animal to Rebel Rescue and will provide the funds to help get the animal current with vaccinations before the animal is adopted to a new family's care.
Do you want to receive updates from Rebel Rescue about future endeavors, sponsorships, and volunteer opportunities?
Rebel Rescue may allow other organizations, whose aims are in sympathy with our own or that offer to benefit animal welfare, to contact our supporters. Do you give your permission to share your email address with our partners?
What is your preferred method of contact? (Check all that apply.)
DO NOT CONTACT
I agree to abide by the adoption declaration stated herein.
By signing below, either by handwriting or by electronic means, you have stated that all information on this application is true to the best of your knowledge and that you will abide by all rules and conditions stated herein. Rebel Rescue has the right to refuse adoption if it is found that information stated on the application has been falsified.
Adopter Signature (Use your mouse or finger to sign on the line.)
Date Signed by Adopter