Adoption Application

 

Personal Information

  • Please provide the following contact information:
    Name
    Street Address
    Address (cont.)
    City
    State/Province
    Zip/Postal Code
    Country
    Work Phone
    Home Phone
    E-mail
    URL
  • Number/Ages of adults in the household:


     

  • Number/Ages of children in the household:

    If you have children, please click here and read this before applying.
     

  • Are you expecting a child or planning a family in the near future?


     

    Environment

  • Type of Dwelling:

    House
    Apartment
    Trailer
    Condo/Townhouse
    Duplex/Triplex
    Other

     

  • Do you own or rent?

    Own
    Rent

     

  • The following two questions are for renters only. If you rent, do you have the landlord's permission to keep a dog?

    Yes
    No

     

  • Please provide Landlord/Apartment contact information for verification:


     

  • How many consecutive hours a day are you away from home for work, school etc.?


     

  • Will you be hiring a pet sitter if gone a long time, or are you close enough to go home during the day?


     

  • If you are interested in a particular dog, please specify who:


     

  • Would you accept a "special needs" dog (vision-impaired, not housetrainable, etc.)? Be specific.


     

  • Are you agreeable to returning the dog, should unforeseen circumstance arise wherein you would no longer be able to keep the dog?


     

  • Would you be willing to allow us to visit your home?


     

  • Have you applied with another Rescue Group? If so, which organization?


     

  • If out of state, will you come get the dog? We do NOT ship dogs unaccompanied.


     

  • Is it securely fenced? If yes, what kind and how tall?


     

  • Do you have a pool? If yes, is it securely fenced?


     

  • If your yard is not fenced, how do you plan to insure that the dog receives safe and adequate exercise?


     

  • Where will the dog sleep? Be specific (kitchen, crate, my bed, etc.)


     

  • Do you plan to keep the dog primarily indoors or out? Please elaborate


     

  • Do you plan to use a crate? Why or why not?

    Current/Former Pets

  • Please tell us about your current dog(s). List the following information for wach dog you currently own: Name, Breed, Sex, Age, whether or not the dog is Spayed/Neutered, and whether the dog lives indoors or outdoors?


     

  • If you own any cats, please list the following information: Age, Sex, whether or not the cat is spayed/neutered, whether or not the cat is declawed, and whether the cat lives indoors or outdoors.


     

  • Please list any other pets you currently own and any pertinent information about them.


     

  • Have your current pets been socialized with (other) dogs? Please elaborate.


     

  • Please list any pets you have previously owned, along with the following information: Breed/Species, how long the pet was owned, was it kept indoors or outdoors, was it spayed/neutered, and where pet is now (if deceased, list cause of death).


     

  • Have you ever had to give up a pet? If so, please tell us why?


     

  • This section is for people who own or have owned a dog. a) If you currently own a dog, where did you get your dog?


     

  • b) What activities do you participate in with your dog?


     

  • c) Have you attended obedience classes with your dog?


     

  • d) What type of Heartworm Preventative do you give your dog?


     

  • e) What type of flea control do you use on your dog?


     

  • f) What do you feed your dog (brand/type)?


     

  • g) Is your dog spayed or neutered? Why or why not?


     

  • h) When nobody is home, where does your dog stay?

    In the yard
    In a crate
    In the garage
    In the house, confined to an area
    In the house, not confined to an area
    In the house with a doggie door
    In an outside run/pen
    Outside on a chain or tie-out
     

  • i) Do you consider your current dog(s) aggressive or submissive to other people? Animals?


     

    Your Adopted Dog

  • What type of behavior(s) do you expect from your adopted dog?


     

  • What amount of time and effort, per week, do you want to devote to training your dog?


     

  • Are you likely to enroll your dog in obedience class?


     

  • Which family members would be expected to assist in home training?


     

  • What is your definition of disciplining your dog?


     

  • What are your training objectives?


     

  • What makes you a good pet owner?


     

    References

  • Please list three references that can attest to your suitability as a pet owner, and more specifically, the owner of a rescued dog. If you have owned any pets in the last five years, you must include your veterinarian as a reference. Include Name, Address, and Phone Numbers.


     

  • I, the undersigned, attest that, to the best of my knowledge, the above information is accurate and complete at the time of signing. I understand that falsely provided information can mean that my application will be terminated. I understand that typing my name and the current date here equals my signatures to this application (please sign and date).


     

    Thank you for your cooperation. A comprehensive questionnaire helps us in placing the right dog with the right family. An improper placement or one in which all the details aren't known, can end tragically, usually for the dog.  By clicking the submit button, you agree that all adoptions are on a trial basis,  you give us permission to check your references and visit your home.  If for ANY reason the adoption does not work out, you MUST return the dog to us, you cannot take it to another shelter, rescue, vet clinic, find it another home or euthanize the dog.  By clicking the submit button you are in a binding agreement with the above mention statement.

     

    • © Copyright 2001-2006 Midwest Pug Rescue. All rights Reserved.

    Revised: February 22, 2008