Jack Russell Terrier Rescue of Colorado

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Colorado Jack Russell Terrier Rescue Adoption Application

Before you fill out the application, carefully read 'About Jack Russell Terriers'.

We place dogs in Colorado and the surrounding states (primarily Utah and Wyoming). If you are in another state, find your state's rescue contact. You may also check The Jack Russell Terrier Club of America for the rescue contact in your state.

All information will be kept strictly confidential and will be used solely for contact information and to determine suitability of the applicant in adopting a JRT.

Use the 'Tab' key or the mouse to move between fields. Bolded entries are required.

Contact information:

First name
Last name
Occupation
Organization
Street address

City
State
Zip
Work Phone
Home Phone
Fax
E-mail
Website:

I live in a:
House
Apartment
Trailer
Other

Do you own or rent your home?
Own
Rent

If you rent, do you have the landlord's permission to keep a dog?
Yes
No

Name of Landlord:

Landlords Phone Number:

How long have you lived at this address? Years: Months:

Do you have a completely fenced yard suitable for a dog?

Do you have a kennel (dog) run?

Fence or kennel run height:

Width:

Length:

If no fenced yard/kennel, how will you handle your JRT's exercise and toilet needs?

Do you have a suitable dog crate?

How many adults in the household?

How many children?

Age and gender of children:

How many hours a day must the JRT spend alone (average)?

Are there other visitors to your home (human or animal) with which the new JRT will have to interact?
Yes
No

Describe your lifestyle:
Active
Passive

How did you hear of JRT Rescue?

Do you own other dogs?
Yes
No

Are they spayed/neutered?
Yes
No

Please list breed, size, sex and age of other dogs:

Do you own cats?
Yes
No

If yes, how many:

Any other animals?
Yes
No

If yes, please describe:

How many dogs have you owned in the past 5 years?

If you do not still own the dog(s), describe what happened to them. Please be specific:

Have you owned a JRT before?
Yes
No

Why did you choose to adopt a JRT?

What activities do you plan to do with the dog?
Pet
Guard
Hunting
Obedience
Attend Terrier Trials
Other

Do you have a regular veterinarian?
Yes
No

Vet's Name:

Vet's Address:

Vet's Phone:

I want to adopt:
Male
Female
No Preference

Age preference:

I would be willing to consider a suitable dog of a different:
Age
Sex
Neither

Are you a current member of the JRTCA?
Yes
No

Personal Reference

First name
Last name
Title
Work Phone
Home Phone
E-mail

Please click the 'Submit Application' button only once.
Thank you!

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