Madres Mutts Adoption Application

Applicant Information

for Madre's Mutts
I am interested in adopting the following dog/s:*
Applicant(s) Name(s):*
Applicant(s) age(s):*
Street Address:*
City, State, Zip*
Primary Phone:*
Format: (000) 000-0000.
Secondary Phone:
Format: (000) 000-0000.
E-mail:*
Employer:
Home Structure Information
Residence Type:*

HouseApartmentCondoMobile HomeFarmOther
If you answered "other" above, please describe:
Do you...*

Own your own homeRentLive in a family home owned by relatives.
If renting, the name and phone number of landlord:
If renting, this landlord has given me permission for pet ownership.

YesNo
What restrictions are there for dog ownership in your apartment, HOA, or subdivision?*

Number of petsSize or weight restrictionsBreed restrictionsNone
My home has a fully-fenced yard.*

YesNo
Fence height and material:
On the property of my home, I have:

Underground fenceKennelDog Run
Household Information
All members of my household are in agreement with this adoption.*

YesNoDon't Know
The primary caretaker of the pet will be:*
Number of adults living in my home and their relationship to me:*
Number of children in my home and their ages:*
The children in my home have experience with dogs or other animals.

YesNoOther
If you answered "other" above, please describe.
In my home, someone has allergies to dogs or asthma,*

YesNoOther
If you answered "yes" above, please describe how allergies/asthma are managed.
Current/Past Pet Information
Please list all pets who CURRENTLY live in your household.
Include name, type/breed, age, gender, alteration status, how long owned, indoor/outdoor.
Include name, type/breed, how long owned, what happened to the pet.
In the past, I have taken a pet to the shelter or given an animal away.*

YesNo
If yes, please explain the circumstances.
I have previously adopted from a shelter or animal welfare group.

YesNo
If yes, please list the name of the group.
The name and phone number of my current and/or previous veterinarian or vet clinic:
New Pet Information
I am willing to provide my new dog with at least this much time to adjust the new home environment:*
I am aware that a new environment is stressful for a dog and acknowledge they may exhibit unexpected behaviors:*

YesNo
I understand that vet costs for the dog may amount to hundreds of dollars per year:*

YesNo
I understand that a dog can be a commitment that lasts up to 18 years.*

YesNo
I have successful experience with house-training a dog or puppy.*

YesNo
This is my plan to let my dog relieve itself:*
If/when the dog has an "accident" in my home, this is my plan to address it:*
I have an awareness of crate training.*

YesNo
The maximum number of hours each day my new pet will be home alone:*
When/if I work full-time or am gone more than 4-5 hours at a time, this is my plan for the dog: *
Location where my new pet will sleep at night:*
My exercise and activity plans for my dog:*
REHOMING/RETURNS EXPECTATIONS

If, for any circumstance, I must relinquish ownership of this dog, I will return the dog to a representative of the Madres Mutts organization. This dog will not be sold, rehomed, abandoned, or be disposed of if custody of this dog is relinquished.
I have read and understand the rehoming/returns expectations.*

YesNo
SPAY/NEUTER EXPECTATIONS

If unaltered, a voucher for a free spay/neuter at the Northwest Spay & Neuter Center in Tacoma, WA is provided. Proof of the successful alteration is necessary to finalize this adoption. (This may not apply to this pet.)
I have read and understand the spay/neuter expectations.*

YesNo
How I discovered Madres Mutts:*

Petfinder.comFacebookFriend/Family MemberOther websitePetSmartOther
I understand that I assume full responsibility for the welfare of this pet from the date of adoption.
Should be Empty:

Applicant Information

Home Structure Information

Household Information

Current/Past Pet Information

New Pet Information