American Brussels Griffon Rescue Alliance

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(To adopt one of our rescued Brussels Griffons, you must be 25 years of age or older)

The American Brussels Griffon Rescue Alliance’s goal is to find permanent, secure and attentive homes for our rescued Brussels Griffons, and we know you want the best dog for your situation. This profile will assist us in making the best match possible between you and the Griff.

We place our Griffs based on lifestyles, temperaments, and the size of the dog, as well as any special needs the Griff might have. Brussels Griffons do not do well with children under 5 years of age and in many cases with children under 10 years of age. We prefer to place Griffs where someone is home most of the time. Brussels Griffons do not do well when they are left alone for more than a few hours at a time. Ideal situations include people that work from home, work part time, are allowed to take their pet to work with them, Doggy day care and pet sitters when not at home.

If you have a question about whether your application has been received, please contact abgralowermidwest@msn.com.

Please answer every question. Please enter "N/A" or "none" if field does not pertain to you. Two personal references and one vet reference are required. If all the questions are not answered fully, we will not be able to consider your application.

If there is a particular dog you are interested in, what is his/her name? If not, please put "No".
First Name (Full Legal Name)
Last Name
Age
Home Phone #	(xxx-xxx-xxxx)
Work Phone #
Cell Phone #
Address

City
State
Zip Code
Your Email Address
Occupation
Spouse’s/Partner's/Other Adult's Name
Spouse's/Partner's/Other Adult's Age
Spouse's/Partner's/Other Adult's Occupation
Spouse's/Partner's/Other Adult's E-mail Address
Do you have children living with you?
If you have children living with you, please enter their names and ages. Otherwise, please enter N/A.
What behavior are you looking for in a Griffon?
What type of Griffon are you most interested in adopting? (Check all that apply)	Companion Companion for Another Pet House Pet Mouser Watch Dog Other:
Would you be willing to adopt a Brussels Griffon mix?
Would you be willing to travel by car or airplane to pick up a rescue?
If you fly by airplane, are you willing to pay extra for the Brussels Griffon to fly in the cabin with you?
What situations would cause you to not be able to keep this dog?
Do you understand that in the event you are no longer able to keep this dog, you are required to return it to American Brussels Griffon Rescue Alliance?
As with any rescue dog, Brussels Griffon are often not housebroken, may eat their poo, have been abused in the past, or may have treatable medical conditions; and, in some cases, these conditions may not be realized until after the dog has been placed in its new home. If you are approved for adoption, are you willing to work with your new pet to give it the new life it deserves even if medical conditions are evident?
Please provide a brief paragraph describing yourself (hobbies, interests, activities)
Which of the following best describes your current residence?
If you rent or lease, the following information is required. If you own your residence, please enter N/A.
Name of Landlord
Landlord's Home Phone
Landlord's Work Phone
Landlord's Address
Do you have a securely fenced yard on your property that will keep a small dog safely contained?
If yes, what type of fence?
If other, please describe
How high is the fence?
Is your fenced yard directly accessible from your home?
Does your pet have access to the doggy door when you are not at home?
What do you use to secure your gate(s)?
Who has access to your yard (meter readers, neighbors)?
How do you plan to allow your pet to relieve itself and/or exercise?
How often do you take your dog for walks or plan to take your new dog for walks?
Do you own a swimming pool?
If yes, is it secured?
If pool is secured, please explain how.
If yes, will the animal have access to it?
What brand of heartworm preventative do you use?
What brand of flea protection?
Do all adults in the household work full time?
Approximately how many hours each day will your dog be left alone?
Where will the dog be kept when left alone?
Do you have any travel plans for the first 6 months after adopting a Griff?
If yes, please explain.
List all other animals that you currently own including name, breed, age, sex, spayed/neutered (Yes/No), and how long you have owned
If you have had pets in the past, what happened to them? Please list each past pet including name, breed, age, sex, spayed/neutered (Yes/No), length of time with you and reason they are no longer with you
Under what circumstances do you believe a pet should NOT be spayed or neutered?
Are there any restrictions on the number of dogs you may own where you live?
If yes, how many are you allowed to have?
Does anyone in your home have allergies to animals?
If yes, please explain
Vet Reference:
Do you have a veterinarian now, or one that you have used in the past?
If you do not have a current vet, what vet will you use, should you be allowed to adopt one of our Griffs, and why did you choose this particular vet? If you have a current vet, please enter N/A.
Vet's Name
Vet's Phone (example: 555-123-1234)
Vet's Address, City, State, Zip Code

Personal References:
Name of First Reference (other than relative)
Address, City, State, Zip
Phone (example: 555-123-1234)
Relationship to you
Do they have pets?
If so, please describe
Name of Second Reference(other than relative):
Address, City, State, Zip:
Phone (example: 555-123-1234)
Relationship to you
Do they have pets?
If so, please describe

How did you hear about American Brussels Griffon Rescue Alliance?
Would you be willing to help a Brussels Griffon in need by:	Making a visit to a local shelter to I.D.? Conducting local home visits for forever homes? Helping to transport? Fostering a Griff in need? Rather not be contacted

ABGRA Rescue Disclaimer
There is absolutely no guarantee intended or implied that any person requesting to adopt a dog being fostered through ABGRA, or posted on the ABGRA web site, will be allowed to adopt a dog. Rather, all adoption applications are subject to acceptance based on a review process that may require collecting information from references and visiting the applicant's home. All decisions on placing dogs in adoptive and foster homes are based solely on the judgment of the volunteers and Directors of American Brussels Griffon Rescue Alliance. Adoption applications submitted through this form may be denied for various reasons. ABGRA reserves the right to make all decisions regarding placement or final disposition of any rescued dog in its care.

ABGRA does not base decisions for placement upon race, color, creed, national origin, religion, age (adults over 25), sex, familial status, sexual orientation or disability status.

By sending this application, you attest that you have read the above disclaimer and agree to the terms therein. Furthermore you represent that the information you have provided on this form is the truth to the best of your knowledge and belief. In the event this adoption application is approved, it will become part of the adoption contract.

Thank you for considering American Brussels Griffon Rescue Alliance!

I hereby forever release, discharge, and agree to hold harmless and indemnify American Brussels Griffon Rescue Alliance; and its members, officers, and volunteers from all claims, demands, actions, causes of action, or liability of any kind whatsoever arising as a result of or in connection with the fostering or adoption of a dog sponsored by this organization.

Digital Signature: Date:

Please note: only click the submit button one time. Double-clicking the button may result in an error message even though your application has been sent. Application may only be submitted once. If you receive an error code message, please contact our Webmaster. We are having some difficulty with the error processing with the application and would greatly appreciate your help!

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