Name of dog you are interested in:
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Name
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First Name
Last Name
Email
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Mobile Phone
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(###)
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Home Phone
(###)
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Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Do you rent or own?
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Type of Housing:
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Do you have a fenced yard?
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(No electric fences will be approved)
If no, how will you contain the dog outside?
Do you have any other pets?
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If yes, please list all pets (including any birds), their sex and ages.
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*Please note if they are also spayed/neutered and up to date on all shots
Have you owned any pets in the past five years that are no longer in your possesion?
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If yes, please explain why this pet is no longer with your family.
Does anyone in your household have allergies?
Have all members of the family agreed to adopting a pet?
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Please list all members living in your home along with ages:
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If you adopt a dog will it be left outside unattended?
If you answered yes, how long will the dog be left unattended each day?
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How many hours on average will the dog be left alone each day?
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Where will the dog live?
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Where will the dog sleep at night?
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How often do you plan on walking the dog?
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What are you looking for in a dog? (check all that apply)
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Which characteristics would you NOT tolerate in a dog (check all that apply)
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If your dog displayed any one of the above traits, what would you do?
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What is the best way to correct your dog's mistakes?
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Under what circumstances would you return your dog to the rescue?
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Personal Reference 1: Name - Not an immediate family member
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Personal Reference 1: Phone Number
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Personal Reference 1: Email
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Personal Reference 1: How does this person know you?
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Personal Reference 2: Name - Not an immediate family member
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Personal Reference 2: Phone Number
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Personal Reference 2: Email
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Personal Reference 2: How does this person know you?
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Medical Reference: Clinic/Hospital Name and Address
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Medical Reference: Phone Number
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If you have any other information you would like to share, please feel free to do so here.
How did you hear about our rescue?
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Agreement
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I understand that I am adopting at my own risk and hereby forever release, discharge and agree to hold harmless and indemnify Mobile Mutts Rescue from all claims, demands, actions, causes or action or liability of any kind whatsoever arising as a result of my choosing to adopt as of the adoption date.
I further agree that I will not make any claim against, sue, attack the property of, or prosecute Mobile Mutts Rescue (or any of its board members/volunteers) for any death, personal injury or property damage, whatever the cause or place of event giving to the claim, which I may suffer or sustain as a result of this adoption.
I further understand that the behavior of domestic animals is sometimes unpredictable and that some domestic animals are capable of inflicting serious injury or death, as well as extensive property damage. Knowing the risks of handling domestic animals, nevertheless, I hereby agree to assume those risks and to release, indemnify and hold harmless Mobile Mutts Rescue and its members/volunteers who might otherwise be liable to me or my heirs or assigns for damages.
My interest in adopting through Mobile Mutts Rescue is strictly my choice, therefore no insurance against bodily harm is provided to me.
Adoption applications are kept on file for one year following approval. If you are a tenant, you must provide a copy of the lease agreement showing that you have permission to keep a pet on the property before completing an adoption. You will need to give your veterinarian consent for us to conduct a pet reference check on you.
I certify that I am at least 21 years of age, and that I have sufficient economic resources to pay for the costs associated with keeping an animal. I authorize Mobile Mutts Rescue to verify any statement I have made in this application. I also understand that Mobile Mutts Rescue has the right to deny my application. By typing my name and date below, I acknowledge the information I have provided is true.
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Date
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MM
DD
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