Every field throughout the entire application must be completed.

Which animal are you interested in adopting? 

Regardless of whether you have named a specific animal above, Please describe your IDEAL PET... your preferences with regard to breed, sex, age, color, small dog, large dog, house dog, yard dog etc:

Your Full Name

Address

No Post Office Boxes Please.

City

State

Zip

E-mail

Home Phone 

Please include area code.

Cell Phone

Include area code.

Co-Applicant's Full Name

Relationship to Applicant

If Married, How Long?

 Employment

Place of Employment

Time Employed?

Employer City, State

Your Work Phone

Include area code.

Co-Applicant's Place of Employment

Time Employed?

Employer City, State

Co-Applicant's Work Phone

Include area code.

 Information About Your Household Members

Please list the people that currently live in your household or visit often.
(Please list relationship to you & their age.  We don't need the children's names.)

Who will be the primary care giver for the newly adopted animal? 
Does anyone in the household have any known allergies to animals?Yes No     If yes, please explain.

 Information About Your Home

Which of the following best describes your current residence? (Check one)
Single Family Home  Mobile  Home  Condo Apartment

Nearest highway to your home: 

How close is this highway to your home? 

Length of time at this address?  

Do you own or rent?  Own  Rent/Lease 

Does your residence have a: (check all that apply) Yard  Fence  Dog Run  Dog Door

If fenced please specify type and height of fence:  Type of Fencing (Materials)   Fence Height

Size of fenced area:

If you do not have a fence, please explain how you will address the dog's exercise and bathroom needs, etc.

Does your residence have a pool or hot tub?   Yes  No

If yes, is it fenced/covered so that pet CANNOT get to it?  Yes  No
Please provide details: 

 The Animal You Want To Adopt

We receive many applications for each dog, and may already be in the process of approving another home for the dog in which you are interested.  If this dog is unavailable do you want Muttley Crew to match you with a suitable companion? (Subject to your approval of course)
YES  NO

Type of companion animal you are seeking: Puppy  Adult Dog Other - Please specify below

Preferred Gender:    Male  Female   No Preference

Color Preferences: (check all that apply) Black& Tan  Black/Red  Black/Silver  Sable  Tan  Black  White  Any Color

Why are you interested in adopting?  Please check all that apply.  Companion for Self  Companion for Family  For Breeding  Gift
For Protection For Child  Replace Previous Pet  Companion for Other Pet  Other - Please specify below

This dog will be a :  House Dog Yard Dog  House Dog with Access To Yard  Guard Dog  Companion

How long will your new dog be left alone (without humans) each day?

Is this your first pet as an adult?  Yes  No

If no, please list pets you have had previously and the duration they were with you. What happened to these animals?

 Your Current Animals

What animals currently live in your household? (Please include the following info for each pet: 
Name of pet, type of pet (dog, cat etc), sex/age, How long owned?  Kept where?)

How do you plan to introduce the new pet to the household?

Are you prepared for the expenses that are incurred annually for veterinary medical costs?   Yes  No

Are your current pets up to date on shots, heartworm preventative, veterinary care, etc?   Yes  No

If not, please specify which ones and why not. 

What brand of heartworm preventative do your use and how often?

Are all your current pets spayed or neutered?  Yes  No

If No, why not?

How will you handle the following potential situations?
Family allergy to pet: 
Pet medical expenses: (emergencies or diagnosed medical condition) 

If you should move what will become of the pet?

Are you prepared to spend several weeks or, perhaps months, helping your new pet adjust to a new environment?  Yes  No

 Your Experience With Animals

Have you ever had any complaints about your pets?  Yes  No
If yes, please explain.

Are your current pets friendly with other animals? Yes  No  

Have you ever had to give up a pet before? What were the circumstances? Where did the animal end up?

Do you plan on having your new pet enrolled in obedience training?  Yes  No
If yes, where:

Please describe any special training or experience you have had with your previous or current animals.

 Taking Care Of Your Newly Adopted Pet

What is the longest duration you will leave your pet unattended outside?

Where will your pet be kept:
At night:

Day time:

How many hours a day will there be someone at home with this pet? 

What brand of food do you plan on feeding your new pet? 

 Your Veterinarian

Please provide the following information so we can contact your current veterinarian.

Vet Name

Vet Address

FULL address please, including city and zip code.

Vet Phone

REQUIRED!  Please include area code.

Date, pet name and reason for most recent vet visit.

We reserve the right to check your status with your vet and to inspect all homes and yards prior to approving any adoption.  Is this okay?
Yes    No

Groomer's Name

Groomer's Address

FULL address please, including city and zip code.

Groomer's Phone

Include area code.

What are your pet's names that this groomer has seen?

 Please List 2 Personal References (unrelated to you & not living in your household)

Name

Phone

Name

Phone

 Almost Done!

Have you applied to adopt from another rescue within the last year? Which organization?

Any other comments you'd like to add for consideration of your application to adopt?

Would you consider volunteering for our organization  Yes  Not At This Time
If yes, which of the following areas interest you?
Temporary Foster Care   Personal interviewing of adoption candidates   Fundraising   Home Visits
Transporting   Computer Assistance  Telephone calling  Representing us at an Adoption Event
Other   PLEASE SPECIFY