Mikey's Chance Adoption Application

Application Status
Internal Notes
Adoption Application

PO Box 4535West Richland, WA 99353 mikeyschance@gmail..com mikeyschance.com
Please answer ALL the questions, an incomplete application will result in a denied application.
- Filling out this application does not guarantee that the dog you choose will be available.
- Completion of this application does not guarantee adoption of a Mikey’s Chance Canine Rescue animal.
- We carefully review each application and place dogs based on a variety of criteria. Ultimately, we will always act in the best interest of the dog.
- We will conduct a background check on each adult living in the home.
- We will contact your vet.
- Mikey’s Chance also conducts home-checks to assure the best possible placement of all our rescue animals.
- PLEASE NOTE: It is our policy to only adopt to homes where the current pets:
  1. Are up to date on vaccinations;
  2. Have been either spayed or neutered; and
  3. Have received routine veterinary care.
  4. Fully fenced yard required for our large and/or highly active dogs.
  5. No children under 5 years old *
*exceptions to this policy can be made but VERY rarely. Exceptions will only be made at the Board of Directors discretion and is dependent on the both the dog and the family's experience.

Applications that do not meet this policy shall be denied.

If you are intending to keep the pet as a yard pet, we will typically deny the application. Our pets are raised as indoor animals, and our foster homes spend a tremendous amount of time socializing them as such. In some cases, we receive pets that are conditioned for indoor/outdoor or outdoor living only. The information will be located in the pet’s profile.

Our utmost goal is to place all Mikey’s Chance animals in loving forever homes, therefore we reserve the right to deny an application if for any reason we believe the applicant’s home is not the right fit for one of our Mikey’s Chance Canine Rescue dogs.

Depending on the dog you are adopting, the adoption fees are $450-$550.
Is there a specific dog(s) that you are interested in? If so, who? *
If the dog you are interested in is no longer available would you like to be considered for another dog that we think might match well with you family?
Personal Information
Your Full Name

First Name Middle Name Last Name
Maiden Name
Leave blank if not applicable.
Your age: *
Date of Birth *

Month Day Year
Date
Street Address: *
City, State, Zip *
Home Phone: *

Area Code Phone Number
Work Phone:

Area Code Phone Number
Cell Phone: *

Area Code Phone Number
Which number and what time is best to reach you?
E-mail: *
Employer: *
Job Position
Household Information
Spouse/Partner/ Roommate

First Name Middle Name Last Name
Maiden Name
Leave blank if not applicable.
Relationship to You
Date of Birth

Month Day Year
Date
Best Contact Number

Area Code Phone Number
Employer
Job Position
If you have any other adults that reside in your household please put their information in this box. Include Full Name, Contact Number, Date of Birth, Relationship to you, and Employer.
Do you have any Children living in the home? (List ages)
Are you planning to have children within the next few years? *

Yes No
Does anyone in your home smoke? *

Yes No
Are all members of your household in agreement with adopting a rescue? *

Yes No Don't Know
Does anyone in your home have allergies to dogs or have asthma? *

Yes No
If yes, explain how you plan to deal with this.

Questions for Cat Owners

(If you don’t have a cat please answer the first question of this section and proceed to the next page) We understand that your cats are already members of your family, and that it’s important that they cohabit comfortably with the new dog. We do our best to evaluate our dogs thoroughly to determine whether they are safe with cats. If the dog presents a danger to your cats by behaving aggressively, we will accept responsibility for taking the dog back and finding it a new home. However, we need to know how committed you are to push through a potentially difficult transition period, while your cats come to terms with the presence of a new dog in your home. We are happy to help with introductions and advice to help ease the transition.
Do you own a cat? *

Yes No
If you own cat(s), have they been tested for feline leukemia?

Yes No
Have your cats been declawed?

Yes No
If yes, why were they declawed?
How do you plan to introduce your cats to the dog?
Cats can take a long time to accept a new canine family member, and sometimes they will react to a new dog by hiding, urinating in the house, acting scared, refusing to come in out of the rain, or a variety of other disturbing behaviors. How long are you willing to let your cats be angry and upset before you give up and return the dog?
Dogs that have been evaluated as safe with cats could chase cats that run from them. What will you do if the dog chases your cats, gets into their space, or annoys them in some other way?

Vet and Personal References

Please provide details about the vet you plan to use or are currently using. If you have recently changed vets, please provide information about the vet(s) you used previously.Please include information for the last 5 years of veterinarian care.
Please be aware that many veterinary practices require owner consent for us to ask them questions. Please call your vet ahead of time to let them know that it is okay for Mikey's Chance Canine Rescue to ask information about your account.
Vet Practice *
If no previous vet please put NA
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
Years with Vet Practice
Does your regular vet vaccinate your pets?

Yes No
If not, where do they get vaccinated?
If you have not been with your vet for 5 years, please put the information of your previous vet along with their contact information.
Personal References

Please provide at least five references who can attest to your suitability as a pet owner. References must be adults, and may not be a person living in your household. Your must provide at least two references that aren’t family members.

Provide name, city, and state where they live, phone number, relationship to you. (ALL bold information must be included.)
Reference One
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province
Phone Number *

Area Code Phone Number
Relationship to You *
Reference Two
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province
Phone Number *

Area Code Phone Number
Relationship to You *
Reference Three
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province
Phone Number *

Area Code Phone Number
Relationship to You *
Reference Four
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province
Phone Number *

Area Code Phone Number
Relationship to You *
Reference Five
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province
Phone Number *

Area Code Phone Number
Relationship to You *
Thank you for your application. The information provided is treated as confidential and is not used for any purpose other than considering the application to adopt a dog. It will only be shared with approved Mikey’s Chance volunteers.
By signing this form and hitting submit I certify that the information provided in this form are true to the best of my knowledge and belief and I understand that my application subject to immediate denial in the event that the above facts are found to be falsified.
Signature *

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