Pet Adoption Application Form

Dog & Cat Adoption Application

Thank you for your interest in adopting a pet from Mustard Seed Farm Animal Sanctuary. Please complete the following fields to the best of your ability and enter "N/A" for any required answers that do not apply.

Applicant Name*

First NameLast Name

Copy of DL*

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Co-Applicant Name

First NameLast Name

Name of Pet You Wish to Adopt*

Email Address*

Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

County of Residence *

Do you own any pets?*

Pet Name(s)

Pet Breed(s)

Pet's disposition and behavior towards other dogs?

Veterinarian's Name*

Veterinarian's Number*

Area CodePhone Number

Upload your most recent vet records here

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Do you own or rent your home?*

OwnRent

If you rent what is the pet policy?*

Landlord Name*

Landlord Phone Number

Area CodePhone Number

Do you have a yard?*

YesNo

If "Yes" to the above, is it fenced? please describe

What type of monthly prevention are your pets on?*

How many hours a day will the pet spend outside?

Please provide photos of your yard and home (interior and exterior):

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

YesNo

If you answered "Yes" to the above question, please provide detail:

Are there any dog breeds you would not consider adopting (please list)?*

Please list all members of your household along with their ages: *

Is everyone on board for adopting your new family member?*

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

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 the names, emails, and contact numbers for 3 personal references:*

Please let them know we will be contacting them

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:

I agree to Mustard Seed Farm Animal Sanctuary's ("MSF Animal Sanctuary") adoption process, will undergo a homecheck, and interview at the discretion of MSF Animal Sanctuary.

I understand MSF Animal Sanctuary will check my references including veterinary and personal.I understand there is an adoption donation associated with adoption of a pet from MSF Animal Sanctuary. I understand this donation will ensure the organization is equipped to rescue another homeless pet.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 MSF Animal Sanctuary BY EMAIL and provide a 14 day period to allow MSF Animal Sanctuary to make arrangents for my pet to be taken back into rescue.I agree to indemnify and hold harmless MSF Animal Sanctuary 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.I understand that MSF Animal Sanctuary will disclose any of the pet's health or behavior issues known before adoption is completed.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 MSF Animal Sanctuary and provide transport to where MSF Animal Sanctuary deems appropriate.I verify all of the above information is true and accurate.I agree to sign this application electronically. By typing my name below I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature.

Signature

Date