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| For questions or comments about the Mercy Application please send an email. | |
Adoption Application | |
Pet Information |
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| Which pet are you interested in adopting?: | |
Personal Information |
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| First Name: * | |
| Last Name : * | |
| Your e-mail address: * | |
| Mailing Address: | |
| Street Address : | |
| City: | |
| State: | |
| Zip: | |
| Telephone : * | |
| Cellphone : | |
| Work phone : | |
| List at least 1 Personal and 1 Professional Reference (Name and Telephone Number) | |
| Employer / School: | |
Home Information |
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| Which best describes your home: | |
| If Other, please describe: |
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| Is your home rented? | No Yes |
| If rented please list your landlord and contact information (phone / address) |
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Pet Information |
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| Primary Veterinarian Reference(s) | |
| Veterinarian Name: | |
| Veterinarian Hospital Name: | |
| Telephone : | |
| Address: | |
| City: | |
| State: | |
| Zip: | |
List all pets owned in the last 5 years |
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| Total number of pets * owned in the last 5 years: | |
Pet 1 |
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| Breed : | Sex: Male Female |
| Name : | Age : year(s) |
| How long has (or did) this pet live with you? : years. | |
| Where is the pet now : | Spayed or Neutered? Yes No |
Pet 2 |
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| Breed : | Sex: Male Female |
| Name : | Age : year(s) |
| How long has (or did) this pet live with you? : years. | |
| Where is the pet now : | Spayed or Neutered? Yes No |
Pet 3 |
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| Breed : | Sex: Male Female |
| Name : | Age : year(s) |
| How long has (or did) this pet live with you? : years. | |
| Where is the pet now : | Spayed or Neutered? Yes No |
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| If more than 3 please list the same information for the others: | |
| How and where do you exercise your pets? |
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| How many hours would the pet be alone on a typical day? |
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Will the entire household share in the care of the animal? Yes No | |
| Where will you keep the new companion animal during the day? |
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| At night? |
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How will this animal be contained when outside? |
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| Why are you looking for a new companion animal? Protection Breeding Purposes The Kids A Companion |
(check all that apply) A Gift Guard Dog Obedience Work Other |
Does anyone in the household have allergies? |
Yes
No
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Are you prepared to give your adoptive animal at least a month to acclimate to the new home? |
Yes
No
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Would you object to a visit by Mercy Fund Animal Rescue? |
Yes
No
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We do not ship animals period. You must come to Marion, NC and pick up your adpotive animal. | |
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You understand that you must travel to Marion, North Carolina to pick up your new pet? |
Yes
No
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Have you ever given a pet away or re-homed a pet? If so, how and why? |
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How did you learn about the animal you are interested in? |
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Who will care for your pet(s) if you are away for any reason - vacation, emergency, other? |
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Is there anything else you would like for us to know? |
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Items marked with an '*'
are required, the form will not submit without answering these items.
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Thank you for your time and interest in our orphaned animals. We will be back in touch after we review your application. Please contact us if you do not receive a notification within 72 hours. |
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Your electronic signature authorizes Mercy Fund Animal Rescue to contact your references and verify the information you have provided in your application. If your application is approved, this document will become part of your adoption contract. Any misrepresentations in this application discovered after the adoption of a pet from Mercy Fund Animal Rescue will result in the immediate surrender of the animal with no compensation due to the adopter. Please realize an incomplete application or inaccurate information on the adoption application will result in your application being denied. I certify that the above information is true. This application remains the property of Mercy Fund Animal Rescue. | |
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 "Mercy Grace" |
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