Name of Dog Interested In
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Would you be willing to consider a different dog if we feel this one is not a fit for you and your family?
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Yes
No
If yes, size, age, and sex?
Will the dog reside in your home?
Yes
No
If no please explain
When are you looking to bring home a new family member?
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Your name
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First Name
Last Name
Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
County
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Phone
*
(###)
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Best time to call
Email
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How did you hear about us?
*Name, gender, occupation and ages of adults in household (18 years or older, include yourself)
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Age and gender of children in the household (anyone 17 years or younger)
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Do you plan on having children in the next 5 years?
Yes
No
What will happen to the dog if you have children or children move into your home?
Are any members of your household allergic to animals?
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Yes
No
If you answered Yes to the above question, please list the type of animal allergic to.
Are there other visitors to your home, human or animal, with which a new dog will have to interact?
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Yes
No
If Yes describe who/what:
Do you live in a House, Apartment, Trailer, ect?
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Describe your property (busy street, acreage, etc.)
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Do you own or rent, or are you currently in the process of buying your home?
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Do you live in a neighborhood that is part of an association?
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Yes
No
If yes please provide contact information of the association
For Renters only: Name of landlord
For Renters only: Landlord’s phone number
(###)
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For Renters only: Does your landlord have breed restrictions
How long have you lived at your current address?
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Do you plan on moving in the next few years?
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Yes
No
What will happen to your pet if you move?
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Do you have a completely fenced yard suitable for a dog?
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Yes
No
Do you have a kennel run or tie out for a dog?
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Yes
No
If no fence, how will you handle exercise and toilet needs?
How many hours a day will the dog be alone?
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Where will the dog be when left alone?
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Are you planning to enroll the dog in obedience/training class?
Yes
No
Who will be the primary care giver for the dog?
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Describe a typical day in the dog's life with you and in your home
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What activities do you plan on doing with this dog?
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Do plan on crating your new dog?
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Yes
No
Do you intend to keep this dog primarily inside or outside?
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Where will the dog sleep?
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Why have you decided to adopt a dog?
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Why did you choose this dog?
What the 5 most important traits in a dog to you?
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Have you had a rescue dog before?
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Yes
No
If yes, from what organization and how was your experience?
List the dogs and other animals currently in your home, including outside pets
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name, age, gender, breed, how long you have owned.
Are the animals currently in your home neutered or spayed?
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Yes
No
If no, explain why
Are the animals in your home current on vaccinations, heartworm testing, heartworm prevention, flea prevention and rabies?
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Yes
No
If no, explain why
Have you ever adopted a dog you were unable to keep?
Yes
No
If Yes, Why?
*Do you plan on adding any additional pets to your home in the next 12 months?
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Yes
No
How many animals have you owned in the past five years that you no longer own?
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Why do you no longer have them?
What would cause you to return a pet you adopted from us?
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Are you able and willing to take on the financial responsibility?
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A dog can cost in the upwards of $600 a year between regular vet visits and food. This amount does not include emergency trips to the vet office.
for those un expected situations
Yes
No
Do you realize that owning a dog is a 15 - 20 year commitment?
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Yes
No
Should you or those in your home be unable to care for the dog due to life circumstances or illness. Do you have a plan in place on what will happen with the dog?
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Yes
No
If yes, please describe that plan and who (outside of your home) would be the one to take the dog. Please provide the name and number of this person so we may contact them
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Is the person named above aware they are expected to take of your pet(s)?
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Yes
No
Do you have a regular veterinarian?
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Please be sure to let your vet know we will be calling.
Yes
No
Vet's name
Vet's address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Vet's phone number
(###)
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Is there another name that the dog’s records may be listed under?
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Yes
No
If there is there a second veterinarian that may also have the dog’s records, enter info here
*Please keep in mind that you are applying for a lifetime companion. Are you willing to make the investment in both time and money to care for and properly manage your new pet (this includes house training, obedience training, food, toys, methods of restraint, yearly license, yearly shots and visits to the vet, possible obedience classes, etc.)
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Yes
No
Are you willing to keep your animal on flea/tick/heartworm preventative?
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Yes
No
*Dogs require yearly boosters, heartworm testing and monthly prevention for flea/tick and heartworm. They may jump on, knock over, and nip at small children if not handled or trained properly. You may need to take your puppy or dog to obedience classes if you are having trouble training on your own. Are you willing to deal with all of these issues and the expenses?
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Yes
No
Reference # 1 Name
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First Name
Last Name
Reference #1 Phone
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(###)
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Reference #1 Email
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Reference #2 Name*
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MUST be a non-family member who has been to your home
First Name
Last Name
Reference #2 Phone
*
(###)
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Reference #2 Email
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Is there anything else you would like us to know about you, your lifestyle, your home, etc. that wasn't included in our application?
Make sure to agree to all statements below before submitting your application
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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.
After adoption I agree to provide Multiple Breed Rescue with address, e-mail and phone number changes. I will provide the dog with adequate food, water, shelter, training, affection and medical care and the dog will not be tied out or left outside unattended for any reason.
I understand that the rescue 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 know about the pet is given to you prior to adoption.