Adoption Application
Miko's Sanctuary - Senior Dog Rescue
Name
*
First Name
Last Name
Email
*
example@example.com
Please let us know which pet(s) you are interested in adopting:
*
List the pet here by name. A list of adoptable pets is available on our website.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Tell us about the people in your household, including the number of members (adults, children, seniors, special needs) and their ages.
*
Please list your current pets, if any, and tell us a little about them (species, age, size/breed).
*
Please list past pets, if any, and tell us a little about them (species, age, size/breed). If numerous, please share those in the last 5 years.
*
If no current or past pets, is this your first pet?
*
0/50
Have you ever surrendered, returned, or given away a pet? If so, when and what was the reason?
*
Please tell us more about your home (size, yard, etc).
*
Do you rent or own?
*
Rent
Own
Does your HOA or landlord allow pets? If so, do they have pet restrictions (such as breed or weight limits)?
*
Where do you plan to keep your pets when you are away from home for work and/or travel?
*
Please list your current vet. If no pets currently, list your past vet. Miko's Sanctuary does check vet references. Please provide your veterinarian's name and phone number below:
*
Veterinarian's name (please provide the name of the practice if you attend a multiple-doctor clinic.)
*
Veterinarian's phone number:
Is there anything else you'd like to share with us?
Emergency Contact: Please list a person to notify in case of an emergency.
*
Emergency Contact First Name
Emergency Contact Last Name
*
Emergency Contact Phone Number:
PLEASE READ BEFORE SIGNING: I understand that completing this adoption questionnaire and application does not guarantee approval for adoption. Failure to provide contact information may void this application. I certify that the information on this application is true and recognize that any misrepresentation of the facts may lead to the loss of any fees paid and my adoption privileges with Miko's Sanctuary. I authorize Miko's Sanctuary to verify all information on this application and will allow an in-home inspection any time before and after the adoption. Please take into consideration a companion animal can live to an age of 15-20 years or more. Please be prepared to make this commitment. By signing below, you are indicating that you have never been convicted of animal cruelty, neglect, or abandonment pursuant to the Code of Virginia § 3.2-6546 D.
*
Submit
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