Name of Dog Interested In *

First Name

Last Name

Would you be willing to consider a different dog if we feel this one is not a fit for you and your family? *

Yes

No

Will the dog reside in your home?

Yes

No

Your name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

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Do you plan on having children in the next 5 years?

Yes

No

Are any members of your household allergic to animals? *

Yes

No

Are there other visitors to your home, human or animal, with which a new dog will have to interact? *

Yes

No

Do you live in a neighborhood that is part of an association? *

Yes

No

For Renters only: Landlord’s phone number

(###)

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Do you plan on moving in the next few years? *

Yes

No

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

Yes

No

Do you have a kennel run or tie out for a dog? *

Yes

No

Do you plan on crating your new dog? *

Yes

No

Are you planning to enroll the dog in obedience/training class?

Yes

No

Have you had a rescue dog before? *

Yes

No

Are the animals currently in your home neutered or spayed? *

Yes

No

Are the animals in your home current on vaccinations, heartworm prevention, flea prevention and rabies? *

Yes

No

Have you ever adopted a dog you were unable to keep *

Yes

No

*Do you plan on adding any additional pets to your home in the next 12 months?

Yes

No

Are you able and willing to take on the financial responsibility? *

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? *

Yes

No

Should you fall ill, whereas you can no longer take care of your pet (moved to a facility that does not allow pets) or should you pass away, do you have a plan in place on what will happen with your pets? *

Yes

No

Is the person named above aware they are expected to take of your pet(s)? *

Yes

No

Do you have a regular veterinarian? *

Please be sure to let your vet know we will be calling.

Yes

No

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? *

Yes

No

*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.) *

Yes

No

Are you willing to keep your animal on flea/tick/heartworm preventative? *

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? *

Yes

No

Reference # 1 Name *

First Name

Last Name

Reference #1 Phone *

(###)

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Reference #2 Name* *

First Name

Last Name

Reference #2 Phone *

(###)

###

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Make sure to agree to all statements below before submitting your application *

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.