Adoption Application - Stephanie's Misfits Rescue

Stephanie’s Misfits Rescue Dog Adoption Application
Stephanie's Misfits Rescue is run by Stephanie Stern who is an independent rescuer (not a 501c3 yet). It is a volunteer, non-profit, animal welfare organization dedicated to the rescue and placement of stray, neglected and abused animals. This rescue is completely funded through fundraising efforts and public donations. All of our pets are cared for by Stephanie in her home, and receive complete medical care, which includes de-worming, vaccinations, spaying/neutering and microchipping prior to their adoption.
This questionnaire is designed to help Stephanie and yourself determine if a specific dog is the right one for you and your household. All adopting parties are required to complete this form prior to adoption. Stephanie's Misfits Rescue reserves the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoptions!
Applicant Information
Name of the dog you are interested in:*
Your full name:*
Date of Birth:*
Street Address:*
City, State, Zip*
Contact Number:

Area CodePhone Number
E-mail:
Occupation:
Household Information
Do you live in a*

HouseApartmentCondoMobile HomeOther
Do you own or rent?*

OwnRent
If rent, provide name and phone number of landlord:
Are there any restrictions from your landlord or subdivision?*

Number of petsSize or weight restrictionsBreed restrictionsNone
Full name and DOB of all adults living in home:
If children, what are their first names and ages?
Current/Previous Pet Information
List all current pets. Please include their name, age, breed, etc.
Are all current pets spayed/neutered?
Have you ever given up a pet?

YesNo
If yes, what were the circumstances?
Please provide the name and phone number of your current and/or previous veterinarian or clinic:
Have you called your vet to release your records to Stephanie Stern?
New Pet Information
What type of personality do you want your pet to have? (i.e. calm, energetic, protective, couch-potato)*
If the dog has an "accident" in your home, what type of correction do you plan to use?*
Where will your new dog stay when nobody is home?*
Are you willing to work through your new pet's issues, if any?*

YesNo
What will you do with your new dog if your life circumstances change (move, have children, etc.)?*
What behaviors are you not willing to work through (that would result in returning your new dog)?*
I understand that I assume full responsibility for the welfare of this pet from the date of adoption.
Should be Empty:

Stephanie’s Misfits Rescue Dog Adoption Application

Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information