Pet Adoption Application Form

Perspective Pet Parent*

First NameLast Name

Name of Pet You Wish to Adopt*

Marital Status*

Age of Potential Pet Parent

Employment Status*

Employer*

Years Employed

Who will care for this dog?*

Where do your dogs sleep?*

Will you stay up to date with Vaccinations? Heart Wormer?*

Are you prepared to care for this pet 10+ years?*

What if your family situation changed?

Sometimes Pets can require large medical expense. Short of going broke, would you take on debt for your pet? *

Would you consider Pet Insurance at some point?

Email Address*

Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Do you own any pets?*

Pet Name(s)

Pet Breed(s)

Do you own or rent your home?*

OwnRent

Do you have a yard?*

YesNo

If "Yes" to the above, is it fenced? *

Please describe. Type of fence? Height of fence?*

Please list at least two references that are not family members.*

Reference Phone Number*

Area CodePhone Number

Reference Phone Number*

Area CodePhone Number

Have you ever surrendered a pet you own to any animal shelter including a "low" or "no kill" shelter?*

YesNo

Are there children in the home? (If yes, please list ages)*

How many hours a day would the pet be alone?*

If you could. please briefly describe a day in the life of a pet in your care.*

Will you crate your pet?*

If you have to leave town, emergently or planned, where would your pet stay?*

How would you deal with behavioral issues such as barking, chewing, destructive behavior, bathroom accidents indoors, unruly leash behaviors in your pet?*

Please provide Name and Contact information for your Veterinarian.*

Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment?*

YesNo

If you answered "Yes" please provide a detailed description:

By clicking the submit button, I agree to Mid Missouri Malamute Rescue adoption process, Mid Missouri Malamute Rescure will be referred to from this point on as MMMR. By clicking the submit button, I understand MMMR. will check my references. By clicking the submit button, I understand there is an adoption donation associated with adoption of a pet from MMMR. I understand this donation will ensure the organization is equipped to rescue another homeless pet. By clicking the submit button, I understand there is no "cooling off" period, and that if I no longer want or can no longer care for my adopted pet, I agree to notify MMMR BY EMAIL and provide a 14 day period to allow MMMR. to make arrangements for my pet to be taken back into rescue. By clicking the submit button, I agree to indemnify and hold harmless MMMR. against any losses, lawsuits, claims, injury, damages incurred by me or to any persons or property by my adopted pet, once adoption has been completed. By clicking the submit button, I understand that MMMR. will disclose any of the pet's health or behavior issues known by the above named rescue group before adoption is completed. By clicking the submit button, I understand that if I no longer want my pet, or am no longer able to care for my adopted pet, I will be directed to surrender my pet to MMMR. and provide transport to where MMMR deems appropriate. By clicking the submit button, I verify all of the above information is true and accurate.

Signature of Potential Pet Parent*