How To Adopt

Adoption Application

Please fill in every field below. If you cannot submit this online application, please email Please save a copy to your hard drive in case of problems.

Today's Date:

Desired Dog's Name:

Your Name : Age:


Street Address: 

City: (must live within 25 miles of Pasadena, CA)


Phone Number for... Home: Work:  Cell:


Type of dwelling:

Do you . . .

If renting, do you have your landlords permission to have a dog? Yes No

Landlord's Name & Telephone number:

Spouse/Significant Other: Age:


Names & ages of Children, if any:

Names & ages of any other occupants in home:

Is there anybody home during the day?  Yes No

Who and during what times?

Has the person who is home during the day met the dog in person yet?  Yes No

What would their responsibilities be with regards to the new dog?  Please explain:

1.  What are your primary reasons for wanting a dog? Check all that apply.
Companion for you Companion for children Companion for other pet
Watch Dog Gift Other - if other, please explain:

2.  If you have children, please describe their previous experience with dogs:

Are you interested in adopting a dog only because your children want one? Yes No

Do you consider yourself a dog lover? Yes No

3.  Does anyone in your household have allergies? Yes No

If yes, please briefly describe: 

4.  Please list all other pets (please include breed, sex and age of each).

Are your pets spayed / neutered? Yes No Some

Have you ever allowed an animal to breed? Yes No

If applicable, are your current dogs mostly:   

Where does each pet currently sleep at night?  

If you have cats are they: 

5.  Where would your new dog sleep at night?
If other, please explain: 
If crate, where will the crate be? 

6.  How many hours per day will the dog be left alone?

When will the dog be when left alone?  Please be specific.

7.  When I am not home my dog will be left:

If inside, where will your dog be if left inside when you are not home?
If other, please explain: 

Are any rooms off limits to the dog when you are NOT home?  Please be specific.

Are any rooms off limits to the dog when you ARE home?

8.  If left outside, what outside shelter is available to the dog?  Check all that apply.
Enclosed Patio Garage Balcony Dog House Shade Trees Other
If other, please explain:

I have a dog door so my dog will have access to both inside and outside.  Yes No

The doggie door opens into the

If opens into other area, please describe:

Do you have a pool? Yes No

If yes, is your pool fenced separately from your yard? Yes No

9.  What outside areas are available to the dog?   (Check all that apply)
Fenced yard Enclosed patio Garage Balcony Dogrun
Unfenced area Other - please describe:

10. Is your yard fenced on all sides? Yes No

What type of fencing do you have?   (Check all that apply)
Chain link Solid Wood Picket Iron bars
Iron solid/mesh Other, please describe:

If other, picket or bars, how many inches wide are any gaps:

Height of fence in feet:  Highest point  Lowest point

How many Gates?  How high are gates? 

11. Have you recently inspected your fence and is it secure, without holes, gaps, or low points? Yes No

If no, and your application is accepted, do you agree to thoroughly inspect your fence
     and make any necessary repairs before the home visit? Yes No

12. Is there any type of lock on the gate(s)?  Check all that apply. 
Padlock Key Other Latch only

If no locks, would you install prior to home visit? Yes No

13. Who has access to your yard?  Check all that apply.
Gardener Pool man Housekeeper Utility Neighbor Contractor Other If other, please explain:

My dog would have access to the yard when workmen are present. Yes No  

If yes has access to workmen, please explain.

14. Preferred level of exercise with dog?

15. When you stay away from home overnight or go on vacation, who will care for the dog (friend, kennel, dog sitter, etc.)?

If a friend or relative, will they care for the dog in your home or theirs?

If in your home, will they: 

16. What kind of food will you feed the dog?
Brand of kibble: 
Brand of canned or other: 

17. Name of regular veterinarian:

If you do not have a vet, would you like a referral?  Yes No

18. Who will groom and bathe your dog?

19. My dog would  wear a collar...

20. Would you allow your dog to wear a Mutts & Moms I.D. tag? Yes No

I plan for my own ID tag to include: 

21. How would you rate your level of dog owning experience:

22. Describe how would you discipline your dog if he or she misbehaved?

23. How would you train this dog? Check all that apply.
Obedience Class Hit with newspaper Verbal commands Clicker or hand signals If other, please describe: 

24. How do you normally walk your dog? On Leash Off Leash

When on leash I normally use (check all that apply). Collar Only Soft Choke Choke Chain Harness
If other collar used, please describe: 

25. Pets are an investment of your time and money.  Can you afford to provide medical care, grooming, proper diet, shelter and exercise for your new pet? Yes No

If your pet required veterinary care, what amount would you be willing to spend?

26. I would return the dog to Mutts & Moms if the dog became ill or required surgery.  Yes

27. Are you able to make a long-term commitment to care for your pet for its entire life span, which could be as much as 10 to 20 years?

  What would happen to your pets if you became ill or were unable to continue living in your current home?

  Are you willing to live with hair on the furniture, stains on your rugs, a warm body on your bed,
     and an animal that might be destructive at times?

28. What would happen to your pets if you moved?  Please describe:


Out of state: 

Out of the country: 

29. Have you ever given a pet away?  Yes No

  If so, please explain: 

30. Which of the following reasons might prompt you to give up your dog?  Check all that apply. Excessive Barking Biting Digging Divorce Moving Homes Poor watchdog Destructive chewing Financial Problems Accident indoors Growling at guests Excessive vet bills Shedding Allergies New spouse/partner doesn’t like dog Aggressive on leash None of the above

31. Will you agree to consult a professional trainer or behaviorist recommended by Mutts & Moms if any problems develop?

   I understand that the going rate for in-home consultation is $150 per session.  Please initial 

32. Please list all pets you have owned since you have been an adult. 
     If former pets are deceased, please explain in detail what happened.

33. How did you find out about our adoption program?

34. Why are you interested in adopting from a rescue?

35. Which dog (or what type of dog) are you interested in and why that particular dog
     (or type of dog)?


Please read each statement below and type your initials in each box as an indication you understand and agree to the terms of this application.

   I understand that a home visit is required prior to final placement.
   I understand that a home visit does not guarantee placement.
   I agree to provide my own collar, leash, choke chain or harness, and personal ID
   at the time of completing the adoption contract.  
   If I do not have these available, I understand that I can borrow these items from Mutts & Moms with a $25 deposit. Crate deposit - $50.   
   I understand that my dog must be walked on harness, soft fabric slip collar,
   or choke chain. Walking my dog on ID collar only puts my dog in unnecessary
   danger and I agree that I will not do it under any circumstances.  
   I can make a donation of at least $250 to help rescue, provide medical care,
   spay and neuter, board and place other abandoned dogs.  
   I understand that any donation or contribution is a gift freely given, not a purchase
   price for a dog.
   No goods or services have been or will be provided in exchange for my donation.
   I understand that my donation is not refundable. 
   Mutts & Moms reserves the right to refuse adoption to any applicant for any reason.
   This questionnaire becomes part of our contract.
Please list the name of the dog you’re interested in again and, in your own words,
tell us why you’re interested in this particular dog.

We strongly recommend having a copy of your completed application saved to your own computer.  Then if there is an email breakdown, you will have a copy and will be able to resend it to us if necessary.  Thank you.


Please press 'submit' to send us this form; we will try to get back to you as soon as possible. 

BE SURE TO CLICK SUBMIT ONLY ONCE - don't double click!


We will then contact you about adopting. Thank you.