Please complete the following application in order to be considered for adoption. Thank you!
Which pet are you applying for? *
How old are you? *
What is your marital status? *
Please list your employment status*
Please list your Employer, City and State
Please list ALL other adults living in the home, along with their ages *
Please list ALL children living or frequently staying in the home, along with their ages*
Do you rent, own your home, or live with someone else? *
If your name is not on the deed, mortgage or lease, please list your landlord or the homeowner's name and telephone number/ contact information
Is your residence a house/ apartment/ trailer/ condo/ other? *
How long have you lived at your current address? *
If you move, what will you do with this animal? *
Do you have a fenced yard? If so, please list type and height of fencing.
If fenced, does it surround the entire area? Is it dog-proof?*
If you do not have a fence, how will the dog be contained to your yard when out for bathroom breaks?
How will you ensure the dog gets enough exercise? *
Where will this dog be kept during the day? *
Where will this dog be kept at night? *
Will this dog ever be chained/ tied/ cabled/ kenneled outside? If so, for how long each day?*
When home alone will this dog be crated/ left loose/ left outside/ kept in garage/ other? *
How many pets do you currently own? *
If you currently own pets, please list each pet by Name, Species, Sex, Breed and Age
(example: Spot - Dog - Male Beagle - 12)
Are all your current pets spayed or neutered? If not, please explain.
Are all your pets current on their recommended vaccinations? If not, please explain.
Are all your current pets good with other animals? If not please explain.
Where do all your current pets live? (Indoors/ outside/ garage/ barn/ kennel etc.)
Please list all other pets you have owned in the last 5 years, and why you no longer have them. If they passed away, please state cause of death. *
Have you ever relinquished a pet to a shelter or rescue, or re-homed any? If so, which pets and why?*
How would you handle unwanted behavior in a pet (such as barking, jumping, biting, aggression, chewing, etc.)*
Do any family members or roomates friends have a dog allergy or a fear of dogs? If so, how will you handle this? *
Have you ever been ticketed/ fined/ convicted of ANY offense concerning an animal? If so, when and why?*
Please tell us why you want this particular pet.
Is there anything else you would like us to know?
How did you hear about us?
Who is your current/ previous veterinarian?
Please list their town, clinic name and telephone number.
Please list two personal references with telephone numbers
(NOT immediate family or living in the same household)*
I understand that the Midwest Pet Refuge makes every effort to place healthy animals, but that they cannot guarantee the health, breed, age or temperament of any animal, and MPR shall not be held responsible for any veterinary or medical expenses which may be incurred.
I understand that I am responsible for and financially prepared to provide proper shelter, food, water and all necessary medical treatment for this pet, including the following: recommended vaccinations, heartworm testing/ prevention, flea control, vet care for unexpected injury/ illness, etc. in order to keep this animal healthy and comfortable as an indoor pet. If this is not done, I understand that the Midwest Pet Refuge has the right to reclaim the animal.
I understand that if I ever cannot properly care for/ have to give up this animal, it MUST be returned to Midwest Pet Refuge. If this is not done, I understand that the Midwest Pet Refuge has the right to reclaim the animal.
I give Midwest Pet Refuge permission to investigate the information provided as well as contact veterinarians and related officials.
I understand that Midwest Pet Refuge reserves the right to refuse the adoption of any animal to anyone for any reason.
I understand that all Adoption Fees and Donations are non-refundable.
I certify that I am at least 18 years old.
I have read the above information carefully and have filled out this application honestly. I understand that omission of information and/or failure to answer all questions and sign the application can result in this application being declined.
If an omission or untruth is discovered after an adoption takes place, I understand and accept that Midwest Pet Refuge has the right to annul the adoption and reclaim the animal.
Please type your signature, thus stating you agree with all the above statements. *