Midwest Animal ResQ Adoption Application
All info obtained is intended only for the purpose of the potential adoption of an animal. Your information will not be sold or shared with outside parties other than Lee's Summit Subaru and Midwest Animal ResQ
Name of specific animal you're interested in (if any):
Full Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Current Employer and Job Title
*
How long at current employer?
*
Residence Info
*
Please Select
Own outright
Mortgage
Rent
Military
Live with family
Live on a college campus
other
How long at current residence?
*
Do you plan on moving soon?
*
YES
NO
What would you do with your animals if you had to move?
*
What type of fencing do you have?
*
List all other people living in your current residence
*
Is anyone in your current residence allergic to animals?
*
YES
NO
Name of your current veterinarian
*
Phone number to your current veterinarian
*
Have you ever given a pet away before, to anyone, for any reason? If so, please tell us about that experience.
*
This dog will be.... (Check all that apply)
*
Companion for self/family
Gift to someone
Inside Dog
Outside Dog
Working Dog (ie hunting, therapy, guard dog)
Other
I prefer a pet with an activity level that is...
*
Please Select
LOW
MEDIUM
HIGH
NO PREFERENCE
Why are you interested in this animal?
*
How much do you expect to spend per year on the care of this pet?
*
This animal needs to get along with the following:
*
Other Dogs
Cats
Kids under 5
Kids over 5
Just me
Men
Women
Other animals not listed
What type of personality are you hoping for in your new pet?
*
What concerns, if any, do you have about adopting a new pet?
*
How many hours per day will this pet be without human companionship?
*
Where will this pet be kept when you're gone?
*
Where will this pet be kept when you are home?
*
Are there any behaviors this pet could have that would be totally unacceptable to you?
*
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. Also, if an omission or untruth is discovered after an adoption takes place, I understand that the rescue reserves the right to annul the adoption and reclaim the animal. I give the rescue permission to investigate the information provided, including conducting a background check, as well as contact veterinarians and related officials. I understand the adoption decision is dependent on many factors, including but not limited to the compatibility of the family and home to the individual pet, and other applications received on this pet. I understand it is the rescue sole prerogative to decide which home is most appropriate, that my application can be denied at any time for any reason, that their decision is final and I will not contest it. It is our goal to place pets in loving, lifelong homes and any information gathered is used only to that interest.
*
YES
NO
SAVE AND COME B
Submit
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