New Adoption Application

What animal(s) of ours are you most interested in? *

Why? *

Name *

Date of Birth *

Phone *

Cell Phone *

Email *

Street Address *

City *

States *

Zip *

How long have you lived at this address? *

Driver’s License Number State *

Employer *

Occupation *

Employment Status *

How Long? *

Address of Employer *

Do you have other household income? *

Employer

Employment Status

How Long?

Type of Residence *

House
Duplex
Apartment
Condo
Mobile Home

Do you rent? *

If yes, what is your Landlord’s Name

Phone Number of Landlord (if applicable)

Are you planning to move in the next 6 months? (Yes or No) If yes please explain.

What are your plans for your pet(s) if you move?

How many adults are in your household? *

How Many Children? And what are their ages? *

Does everyone in your home know your plans to adopt? *

Is anyone in your household allergic to animals? *

If yes, what are your plans to control these allergies?

What is your Dog Ownership Experience? *

I am a first-time Dog owner
I have had one or two in my life
Very Knowledgeable/Experienced

Who will be primarily responsible for this animal? *

Where will the animal be kept when you’re not at home? (Check all that apply) *

In the house (free roam)
In a Crate
In a closed-off room
In the basement
In the Garage
Outside Kennel
Tied Outside
Other

How do you plan to contain the animal when he/she is outside? (Check all that apply) *

Tied Out
Underground/Invisible Fence
Fenced Yard
Dog House
Free Roam
Other

On Average, how many hours per day will the animal be left alone? *

Are you familiar with Crate Training? *

How would you resolve behavior problems such as chewing, barking, digging, fence jumping, etc.? *

Are there any behaviors that you would be unable to live with/tolerate? *

Where will your dog stay if you travel or go on vacation? *

Have you ever adopted from this shelter? *

If Yes, when?

Have you been not chosen or declined?

If yes, please explain

Have you ever adopted from another shelter? *

If Yes, when?

Have you been not chosen or declined?

If yes, please explain

Have you ever surrendered a pet to a shelter? *

If so, when?

If yes, what shelter?

Why?

How many pets live in your home now? Please List: Name, Breed, Age, Sex, Sp/Nu? Still Own? Vac. Current? *

Veterinary Clinic(s) Used and their Phone Number *

List all other pets you have owned in the last 5 Years. Name Breed, Age, Sex, Sp/Nu? Do you still own this pet? *

Veterinary Clinic(s) Used and their Phone Number *

Please explain the type of personality you are looking for in a new pet. *

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Confirmation *

I Understand

BY SIGNING BELOW, I CERTIFY THAT THE ABOVE INFORMATION IS TRUE TO MY KNOWLEDGE, AND I RECOGNIZE THAT ANY MISREPRESENTATION OF FACT MAY RESULT IN LOSING ADOPTION PRIVILEGES. I UNDERSTAND THAT COMPLETING AN APPLICATION FOR ANY LISTED ANIMAL DOES NOT GUARANTEE THE ACCEPTANCE AND FINALIZATION OF ADOPTION FOR SAID ANIMAL. I UNDERSTAND THAT IF MY APPLICATION IS NOT CHOSEN FOR SAID ANIMAL, I MAY STILL BE ELIGIBLE TO ADOPT ANOTHER ANIMAL AT ANOTHER TIME FROM M.C.A.S. AND THAT MY APPLICATION WILL BE KEPT ON FILE AT M.C.A.S. I AUTHORIZE INVESTIGATION OF ALL STATEMENTS IN THIS APPLICATION AND UNDERSTAND THAT VETERINARIANS, OTHER ANIMAL SHELTERS, LANDLORDS, ETC. MAY BE CONTACTED. I CERTIFY THAT I AM AT LEAST 18 YEARS OF AGE. I UNDERSTAND THAT THIS APPLICATION IS NOT AN ADOPTION CONTRACT, AND THAT THE ADOPTION WILL BE DELAYED UNTIL MY APPLICATION (AND OTHER APPLICATIONS THAT MAY BE RECEIVED FOR THE SAME ANIMAL) HAS BEEN FULLY PROCESSED.

Name *

Date/Time *

Bob’s House for Dogs

Adoption Application