Apply for Adoption

Rescue Statement of Commitment

We reserve the right to refuse any applicant for any reason if we feel the needs of the dog will not be properly met or the adoption is not in the best interest of the dog. Russell Refuge, Inc. is a non-profit 501(c)(3) corporation, therefore the adoption fees are donations to help us continue the work in helping dogs in need. The medical history of the dog is provided to the best of Russell Refuge's ability, as well as shots necessary for adoption.

Please fill out the following application completely. The adoption process is designed to match appropriate homes with appropriate dogs. While many dogs may be attractive to the eye, we are very careful to understand the lifestyle of each adopter since we clearly understand the individual dogs in our care and not all Jack Russell terriers are the same.

Russell Refuge does not ship dogs and requires that the applicant come to Russell Refuge (in Rhinebeck, New York) to meet us and the dog before an adoption will be made.

We have many dogs here at the Refuge that are not pictured. We may have the perfect dog for YOU!! If you are interested in the possible adoption of a terrier, please submit our on-line application. Do not be shy about adding additional comments. It will help us to get to know you better. Our goal is to place terriers in happy, forever homes where the adopting party and dogs are both winners. Thank you for considering a Refuge Jack!!!

Applicant Information In this section, please enter information about yourself. Applicant Name: Street Address: City: State: Pick State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington District of Columbia West Virginia Wisconsin Wyoming Test Only   Zip: Home Phone Number:   Work: Email Address: Your Occupation: How did you hear about Russell Refuge? Who lives in your household? Age (range) of adults in household? (check all that apply) 20-29 years 30-39 years 40-49 years 50-59 years 60-69 years 70-79 years 80+ years Age and gender of your children? Are there a lot of children in the neighborhood and/or do children frequently visit you? Yes  No Ages of those visiting children? The relationship of the visiting children to you? Are you planning on having children in the next five years? Yes No Don't Know Not Applicable No Answer Describe a typical day in the dog's life with you and in your home: Why have you decided at this point to adopt a Jack Russell terrier? Have you had a rescue dog before? If yes, describe the situation: Please list the dogs/animals in current home (age, sex, breed, temperament, socialization w/other dogs). This question must be answered in full - if you have other animals are they neutered or spayed? How many dogs have you owned in the past 5 years? If you no longer own a dog, please give the reason why: Name (if known) of the Refuge terrier you would like to adopt: Sex Preference: No Preference Male Female Age Preference: Would you consider a cross? Yes  No Would you consider a dog that has a behavioral problem (for example; separation anxiety or fear) that might be controlled or cured with training/behavior modification? Yes  No Would you consider a dog with a physical problem (for example epilepsy, etc.) that might be controlled or cured with the use of drugs or surgery? Yes  No Would you consider more than one dog? Yes  No Pick the 5 most important descriptions of what you are looking for in this new dog: Obedient Playful Easy going Energetic Focused Athletic Housetrained Good w/ kids Good in car Performance sports Affectionate Calm Walking/hiking Good w/ other dogs Eager to bond Smart Needs nurturing Good w/ cats No issues w/ people Other than dogs, are there other animals in the house? Yes  No If so, how many and what kind? Housing/Landlord Information Do you own or rent your home? Own  Rent If you rent, do you have your landlord's permission to have pets? Yes  No Landlord Name:   Phone: Describe your property (busy street, acreage, etc.) Years at present address?   (Years) Are there regular visitors to the home with whom the dog will interact? Yes  No Is your neighborhood urban, suburban, rural? Urban  Suburban  Rural Do you live in an apartment, condo, mobile home or single family home? Apartment Condo Mobile home Single family home Do you have a fenced yard? Yes  No If so, how high is your fence? If so, how large is your fenced area? How do you intend to exercise this dog? How many hours a day must terrier be alone? hours Where will the dog be when alone (please be specific)? Are you planning to enroll the dog in obedience/training class? Yes  No Who is the primary caretaker? Veterinarian Information Do you have a regular veterinarian? Yes  No   (If "No", skip this section) Vet Clinic Name: Doctor Name: Street Address: City: State:   Zip: Vet Phone Number: Date of Last Vet Visit: Reference Information In this section, please enter your references. Please note that two references are required. Personal Reference #1: (Name/Relationship/Phone) Personal Reference #2: (Name/Relationship/Phone) Comments: Adopter's Statement of Commitment I agree that all of the information I have given in this adoption form is true and complete. I agree that this dog will reside in my home. I will provide the dog with adequate food, water, shelter, training, affection and medical care and the dog will not be tied out or on a run. I understand that Russell Refuge is not responsible for the accuracy of information received about the temperament, habits or physical condition of the dogs available for adoption. However, all information provided is given in an effort to do the best in knowing a dog prior to adoption. Real Person Detector Enter the verification code shown below: This helps Russell Refuge prevent spam applications. Please review your answers carefully before submitting this application to Russell Refuge