Adoption Application

Contact Information

First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
-

County*

Country

Email*

Home Phone

Work Phone
x

Cell Phone

Text/Pager Email

*=required

How many people reside in your household*

Please list your age and the names and ages of anyone in your household.*

Do you have any health concerns that may prevent you from caring for this dog/puppy at any time? If yes please explain details and how you plan to overcome this issue.*

Have you considered the time, effort, patience and hard work that it takes to bring a new dog/puppy into your home? Have you considered the possiblity of sleepless nights, potty accidents in the house, etc while the dog/puppy is adjusting to your home? Finally are you prepared to give 150% effort, time, energy to making sure you are this dog/puppy forever home and the consequences of making a snap decision to get a pet without thinking out all of the possibilites?*

Please list your current place of Employment.*

Please include a link to your Social Media account (re Facebook, X, Insta)*

I have read the description of this dog and understand what type of home is required. Descriptions can be found on mommyandmerescue.com

Yes

Who in the household will care for the pet*

Veterinarian's Name and Phone Number*

Please list the pets that you currently/recently owned. Including name, species, age.*

List at least one reference (who is not a family member) Please include PHONE NUMBER!*

Which animal are you interested in

In what type of home do you live*

Do you own or rent your home*

If you rent, please enter your landlord's name and phone number

If you rent, have you received the approval of your landlord to have an animal

How much time will the animal spend alone during the day*

Where will the animal sleep*

Describe how you will train the pet*

Is your yard fenced*

Why are you interested in adopting a pet at this time*

*=required