Thank you for your interest in adopting a pet from Medical Animals In Need! To help ensure the best possible placement of our rescued animals, and in order to determine that the proposed adoption is in the best interest of the animal, please complete each of the following questions. Please be sure to answer each question carefully and honestly.
We require meet and greets with all owned dogs as well as a home check as part of our adoption process. For renters, we also require a copy of the landlord pet agreement/paid pet deposit & info on any breed restrictions at the location.
Medical Animals In Need reserves the right to refuse adoption to any applicant.
First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
Email*
Home Phone
Work Phone x
Cell Phone*
Alt Email
Type of animal you wish to adopt*
Name of Animal Sorry, no animals found
Optional: Name of animal if you do not see them on our website.*
Spouse's name
Name of personal reference
Place of employment
Reference's phone number*
Do you live in a
Do you rent or own?
Landlord's name and phone number
Are pets allowed
Do you have a fenced-in yard?
What type of fence is it and how high is it?
If you do not have a fenced in yard, what arrangements will you make for toilet duties?
Do you have a swimming pool?
If yes, is it fenced?
Are you willing to work with your dog(s) on how to get out of the pool?
Number of children living in the household
Number of adults in the household
Have allergies to animals been a problem for any household member?
Are all family members aware that you are considering adopting a pet?
Do they all approve?
If no, what are their objections
Do you currently own pets? *
Total number of animals
Are they current on their vaccinations?
Name, type/breed and gender of currently owned pet
How long have you owned this pet?
Is this pet neutered/spayed?
Have you had other pets in the last five years?
If yes, what happened to them?
Have you ever given up a pet for adoption?
If yes, please explain the circumstances.
Have you ever adopted from M.A.I.N. before?
Have you ever returned an animal to M.A.I.N?
Will someone be home with your pet during the day?
What is the greatest number of hours the pet will spend alone?
Where will the pet spend most of its time?
Where will your new pet's main sleeping quarters be?
Is there someone home at night?
Do you plan to travel with your pet?
If not, where will the pet stay while you are away?
Have you ever taken a dog to obedience class?
Have you ever crate trained a dog?
What type of activities do you plan for you and your dog?
Are there any other things that you wish for us to consider when reviewing your application?
What type of animal are you looking for?
What sex of animal are you looking for?
What age of animal are you looking for?
Would you accept an animal that has a treatable medical condition?
Why do you wish to adopt this type of animal?
Would you allow a M.A.I.N. representative to do a home check? *
Name of current veterinarian
Name and location of animal hospital
1. You will abide by your city's leash law and licensing requirements. 2. You will return the animal to M.A.I.N if you feel for any reason you cannot keep him/her. You must not sell or otherwise rehome the animal without notifying M.A.I.N. 3. You are responsible for providing proper shelter, food, water, exercise, medical care and humane treatment at all time for your companion animal. I certify that the information given on this application is true and correct. If I am approved by M.A.I.N. to adopt an animal, I agree to all the above requirements. I understand that failure to comply with any of the requirements will result in confiscation of adopted animal. * Choose one: I agree
How did you hear about us?
Please select if you are interested in helping Medical Animals In Need (Choose all that apply)
By submitting this Medical Animals In Need Adoption Application I am testifying that it, and all accompanying documentation, is true and factual. Medical Animals In Need reserves the right to reject any application for any reason at any time. * Choose one: I agree