Pet Adoption Application Form

Mt. Pleasant Animal Rescue Adoption Application

Today's Date*

Date

Your Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Email Address*

Phone Number*

Area CodePhone Number

*Drivers license information must be provided if you are approved for adoption.

Employer Name*

Employer Phone*

Name of Pet You Wish to Adopt*

Do you currently own any pets?*

YesNo

For each pet you currently own, please list their name, breed, if male or female, and age.

For each pet you currently own, please indicate if they are spayed/neutered and up-to-date on vaccines.

What is your pet's disposition and behavior towards other dogs and cats?

If you currently have dogs, are they on a heartworm preventative?

YesNoOther

Please provide your veterinarian's name and phone number:

How many pets have you owned in the past 10 years and what became of them?*

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

YesNo

Do you own or rent your home?*

OwnRent

If you rent, please provide your landlord's name and phone number:

If you rent, what is your landlord's pet policy?

Do you have a yard?*

YesNo

If you answered "yes" to the question above, is it fenced in and how how high is the fence?

Do you live in:*

CityRuralFarmOther

Where will your pet live during the day?*

IndoorsOutdoorsOther

Where will your pet sleep at night?*

IndoorsOutdoorsOther

Have you considered the expense of this pet, both routine and unexpected illnesses?*

YesNo

Have you ever been convicted of a crime?*

YesNo

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

How did you hear about Mt. Pleasant Animal Rescue?

Is there any other info that may be helpful in evaluating your application?

By clicking the submit button, I agree to the Mt. Pleasant Animal Rescue adoption process, will undergo a homecheck, and interview at the discretion of Mt. Pleasant Animal Rescue. By clicking the submit button, I understand Mt. Pleasant Animal Rescue will check my veterinary references. 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 Mt. Pleasant Animal Rescue. By clicking the submit button, I verify all of the above information is true and accurate.

Signature of Potential Adopter*

Must be 21 years of age.