First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Cell Phone

*COMPLETE ALL REQUIRED FIELDS ON THE APPLICATION (incomplete applications will be rejected)

*REVIEW YOUR INFO FOR ACCURACY (If your pet was vetted under another person's name, please note this on the application)

*BE SURE YOUR OPERATING SYSTEM IS UP TO DATE TO AVOID SUBMISSION ISSUES 

*YOU WILL RECEIVE CONFIRMATION ONCE YOUR APPLICATION HAS SUCCESSFULLY SUBMITTED 
 

What is the name of the animal you are interested in?*
Choose an animal: Alvie Amarilla Anna Anthony Edwards Arrow Batman Belisama Bert Big Mama Blanket Bruce Cammie Bella Charlie and Dracula Cheerio Chicky The Chicken Cinderella Cocoa Puff Copper Corn Cupcake Kisses & Muffin Cup Daisy Damona Dayzee & Zoey Dracula Ember Esmeray Evie Fergie Ferris Fidget Flake Frank and Red Fruit Loop Gary Grisco Henry VIII Honey Jalapeño Jerry Josi Kyleigh Laddie Leo Little Foot Luna Marly Mochi Moo Odie Oregano and Myna Oreo Peanut Fluffernutter & Sweet Pea Tinkerton Perla and Blossom Petunia Pip Pippin Puddin' Pumpkin Raphael Rex Rice Crispy Rodney Sadie Scotch and Neo Shilo Smoke (must be adopted with Walter and Walter) Smudge Snow White Snowflake Strawberry Swimmie Tunie Walter (must be adopted with Smoke and Smoke)

List any other animals you would also like to be considered for:

Birthdate: (Must be 18+ Years of age)*

Best way to contact you?(Check All That Apply)

Any violent criminal history for ANYONE living in the household? *
Choose one: Yes No

How many children living in the residence? *

Ages of Children in Residence (Check All That Apply):

FULL Name, include maiden name, or other names used, Birthdate and Occupation of All Adult Members Living in the Residence*

Are all adults in the home ready for a new pet?*
Choose one: Yes No Still working on it

Any known or suspected allergies and or health concerns with household members that would inhibit contact and or the ability to provide care or for a pet?*
Choose one: Yes No Possible

If Yes, Please Describe:

Housing*
Choose one: Own Rent

Housing Type
Choose one: Apartment Condo Duplex Farm House Mobile Home Town Home Other

If Mobile Home/Trailer: Is your mobile home within a community/park that you provide lot rent?
Choose one: Yes No Does Not Apply

If Yes, please provide the Mobile Home Park's information in the landlord section of this form.

How long have you lived at your current residence?*

Are there any anticipated plans on relocating in the future? *
Choose one: Yes No Possible

RENT: Landlord's name and phone number. NA if not applicable.

Landlord's Email Address:

Are you aware of the Animal Policies in place by your Landlord? (Ex: Is there a deposit required or monthly fee?) Describe:

Where will the animal be while you're home?*

Where will the animal be while you're sleeping?

Where will the animal be while you're not home?*

On average, how many hours will the animal be left alone per week?

Any anticipated work, hour and our location changes in the future?
Choose one: Yes No Possible

If Yes, please explain:

Do you currently have pets?*
Choose one: Yes No

Do you intend to declaw your cat /or kitten once adopted?*
Choose one: Yes No Unsure Does Not Apply

List ALL Pets in the Home & Provide All Info Asked Below: *Incomplete applications will be rejected* Pets Name: Type: Age: Spayed/Neutered: Most recent Rabies Vaccine: Most recent Distemper Vaccine:

Please provide your 5 year pet history include: Name, type, age, they left your home and why they left your home (death, rehome etc…) IMPORTANT: If your resident pet is not utd or altered we cannot process your application without a vet verified medical reason. We will call to verify, please give your vet clinic permission to speak with MSAR or we cannot process your application. *

Describe your or your family's overall average activity level and include favorite hobbies? *

What age of pet best suits your and your family's energy level, hobbies and lifestyle? (Check All That Apply)

Preference to Male vs. Female?
Choose one: Male Female Doesn't Matter

What traits are you looking for, best suited for your lifestyle and most appealing to you in a pet?

Reference #1: Full Name (References can NOT be family members or related)

Reference #1: Email

Reference #1: Phone Number

Reference #2: Full Name (References can NOT be family members or related)

Reference #2: Email

Reference #2: Phone Number*

IMPORTANT

If your resident pet is not UTD on vaccinations, rabies or altered, we cannot process your application without a vet verified medical reason. Please give your vet clinic permission to speak with MSAR or we cannot process your application.

Not sure if your pet is current?  Please contact your vet to check. Incomplete applications will be denied and you will need to reapply once your resident pets are current with all vetting. 

Name of your current veterinary clinic that has up to date information about your pet? (If you do not have a vet please list one you intend to use):*

Vet's Phone Number: (Required field: If no vet, please enter NA)*

Vet's Address:

Have you ever adopted from MSAR?*
Choose one: Yes No

If yes, please provide the Name of animal(s), type of animal(s), and approximate date(s) of adoption: (Enter N/A if this does not apply)*

How did you hear about us?

I Certify That the Above Information is True and Accurate and I Have Read the Disclosure Above: (enter name for signature)*