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Application to Adopt 30
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Please list the name of the dog you’re interested in and tell us why you’re interested in this particular dog. If you don't have a preference, please indicate puppy or adult or any. Thank you!
Your Name
First
Last
Age
Occupation
Spouse/Significant Other Name
First
Last
Age
Occupation
Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Phone
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Secondary Phone
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Email
Please list anyone else living in the home (children.roommates,family etc with ages)
Type of dwelling:: House, Condo, Apt, Other
Do you Rent or Own?
If renting, do you have your landlord’s permission to have the type of dog you want to adopt?
Landlord’s name and phone number:
What are your primary reasons for wanting a dog? Companion for you, For your kids, Gift, For other pet, Watchdog, Other (please explain)
If you have children, please describe their previous experience with dogs
Does anyone in your household have allergies?
If yes, describe
Do you have any pets now? How Many?
Type of Pets (if dog, list breed): Ages:. Sex(es): Other Pets:
Are your pet/s spayed/neutered?
Is there anybody home during the day? Who?
When will the dog be inside? Outside?
About how many hours will the dog be left alone?
Where will the dog stay when he/she is home alone? (please be as specific as possible; i.e. run of the house, a specific room, a crate, etc.)
Where will the dog sleep at night? Dog House, Garage, Inside: If inside, where exactly? Kitchen,, Master bedroom, Spare Room, Laundry Room, Run of the house, Other: If other or if you have additional comments on where the dog will sleep, please specify:
What rooms are off limits to the dog?
What outside areas are available to the dog? Fenced yard Enclosed Patio Garage. Dog House Unfenced common area Other (Not having a fenced yard does not automatically disqualify you as an adopter)
Do you have a doggie door?
Type of fencing? (Chain link, wood, block wall, etc.)
Height of Fence? __Highest Point. __Lowest Point
I have recently inspected my fences and its in good condition. Yes or No
The fence is intact on all sides and is at least 6 feet from the ground level in all areas. Yes or No
I promise to inspect my fences thoroughly before the home visit and make necessary repairs for the safety and well being of our new Pet. Yes or No
Are there gate? Yes or No
How many gates?
How High?__ft.
Is there any type of lock on the gate(s)? Yes or No Type of lock if yes (padlock, key, latch, etc.)
If no locks, would you be willing to install them prior to placement should this application be accepted? Yes or No
Who has access to your yard? Gardner. Pool man. Utility. Neighbor. Other, please explain:
Preferred level of exercise with dog: Couch potato. Short walks. Vigorous walks. Hike or jog regularly.
When you go on vacation, who will care for the dog? (friend, kennel, dog sitter, etc.)
What kind of grain-free food will you feed your dog?
Do you have a regular vet? Yes or No
If yes,
Name:
Address:
Phone:
Would you like a referral to a vet? Yes or No
Who will groom and bathe your dog?
Would your dog wear a collar? Yes or No
When?
Would you allow your dog to wear an I.D. Tag? Yes or No
How would you rate your level of dog owning experience?
First time owner.
Beginner.
Intermediate.
Advanced
How would you discipline your dog if he or she misbehaved?
How would you train this dog?
Obedience class.
Hit with newspaper.
Firm verbal commands.
Clicker/ hand signals.
Other, Explain__________________
How do you normally walk your dog? On leash. Off leash
When on leash do you normally use? Collar only. Corrective collar. Harness.
Are you willing to live with hair on the furniture, stains on your rugs, a warm body on your bed, and an animal that might be destructive at times. Yes or No
Pets are an investment of your time and money. Can you afford to provide medical care, grooming, proper diet, shelter, and exercise for your new pet? Yes or No
Are you able to make a long-term commitment to care for your pet for its entire life span, which could be as much as 10 to 20 years? Yes or No
What would happen to your pets if you moved?
Locally?
Out of State?
Out of the Country?
Which of the following reasons might prompt you to give up your dog? (List all that apply):
Excessive barking
Biting
Digging
Moviing
Divorce
Poor watchdog
Destructive chewing
Financial Problems
Occasional accidents indoors
Growling at guests
Excessive vet bills
Shedding
Allergies
New Spouse/ partner doesn’t like dogs
Aggressive on leash
None of the above
Comments
Please list pets you have owned since you have been an adult and the length of ownership; if they are no longer with you, please provide an explanation:
Two Personal References not living with you:
Name:
Address:
Phone:
Length of time known:
Name:
Address:
Phone:
Length of time known:
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How did you find out about our adoption program?
Why are you interested in adopting from a rescue?
Please read and initial each statement bellow:
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I understand that a home visit is required prior to final placement
Please read and initial each statement bellow:
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I understand that a home visit does not guarantee placement
Please read and initial each statement bellow:
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I CAN give a non-tax-deductible gift of at least $300 to help rescue, provide medical care, spay, and neuter, board and place other abandoned dogs. This is the only cost to adopt your dog.
Please read and initial each statement bellow:
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I agree to provide my own collar, leash, corrective collar or harness, and a personal ID tag at the time of completing the adoption contract
I, Meaza Ridley with JMM Rescue reserve the right to refuse adoption to any applicant for any reason. This questionnaire becomes part of our contract. MSR
Clear
Please list the name of the dog you’re interested in again, and tell us why you’re interested in this particular dog. Thank you!