("MCAP") --- PET ADOPTION APPLICATION
MCAP keeps your information private.
This application is for a:
Dog
Cat
Puppy
Kitten
Name of dog/cat(s) you are interested in:
Applicant Information:
Last Name:
First Name:
Middle Initial:
Your Age:
Full Name of Spouse/Partner, including their middle Initial:
E-mail:
*
Roommate(s):
Street Address:
City:
State:
Zip:
Home Phone:
-
Area Code
Phone Number
Cell Phone:
-
Area Code
Phone Number
Occupation:
Spouse/Partner Occupation:
Work Schedule:
Spouse/Partner Work Schedule:
Names of all persons living in your household, their relationship to you and their ages:
Does EVERYONE in your family want to adopt?
Yes
No
NAME of personal reference #1:
Relationship to you?
Phone Number:
-
Area Code
Phone Number
NAME of personal reference #2:
Relationship to you?
Phone Number:
-
Area Code
Phone Number
Home
Type of Dwelling:
Home
Apartment/Other
Own
Rent
Military
If you live in a condo or apartment what are the association's rules about pets?
Your home has:
1 story
2 story
If not a home owner, do you have the landlord's permission to have a pet?
Yes
No
Landlord's Name:
Phone:
-
Area Code
Phone Number
Would you object to an inspection of your home by a rescue volunteer?
Yes
No
Swimming Pool
If adopting a dog, do you have a pool?
Yes
No
If you have a pool, is it fenced?
Yes
No
How do you introduce a dog to a pool?
I don't know, but would welcome advice:
Yes
No
Your Companion Animals
Do you have the financial means to spend hundreds or even a few thousands of dollars on veterinary care for your pet should the need arise?
Yes
No
Do you presently have a dog or cat?
Yes
No
Have you previously had a dog or cat?
Yes
No
Current Dog(s) Cats(s)
Breed of Pet (1):
Age:
Spayed/Neutered?
Yes
No
Pet History
Gave away
Sold
Lost
Took to pound (Explain)
Other (Explain)
Still have pet
Explain:
Breed of Pet (2)
Age:
Spayed/Neutered?
Yes
No
Pet History
Gave away
Sold
Lost
Took to pound (Explain)
Other (Explain)
Still have pet
Explain:
Additional Pets:
Have any of your dogs/cats ever had puppies/kittens?
Yes
No
If yes, you bred for (Check all that apply.):
Fun
Profit
Show
Other (Explain)
Explain:
Has any member of your family ever experienced animal-related allergies?
Yes
No
Have you ever trained a dog in obedience classes?
Yes
No
Other Pets
Do you have other pets?
Yes
No
How Many?
Species:
Where are they kept?
How long have you had pet(s):
If you have a cat, is it de-clawed?
Yes
No
Veterinarian
Name of Vet:
Phone Number
-
Area Code
Phone Number
Your New Dog/Cat
Your primary reason for adopting:
Compainion for me
Companion for child
Companion for dog
Gift
Watch dog
Who would be responsible for pet's care?
Where will your pet sleep?
Indoors
Outdoors
Where?
Hours per day pet will be left alone?
Where would the pet be left when he/she is alone or when you are away from your home?
Indoors
Outdoors
If outdoors:
Yard
Patio
Kennel
Garage
Other
Doggy Door?
Yes
No
Fenced?
Yes
No
How high is your fence?
What kind of fence?
Wood
Chain
Other
Have/Would you use a pet-sitter or pet daycare center?
Yes
No
When home, pet will be:
always - indoors
mostly - indoors
always - outdoors
mostly - outdoors
Other
If pet will be outside at all, what outside space is available?
Garage
Dog run
Fenced yard
Unfenced yard
Yard
Balcony
Other
How do you plan to handle pet’s exercise needs?
Do you travel a great deal?
Yes
No
How often?
How long at a time?
When you do travel, how do you intend to provide for the pet while you are gone?
If a pet became destructive to your home, what would you do?
Do you have any “musts” for a pet? If yes, please elaborate:
What provisions would be made if you had to move? Locally?
What provisions would be made if you had to move? Out of state?
What provisions would be made if you had to move? Where no pets allowed?
If adopting a dog:
Do you feel obedience training makes a dog a better companion?
Yes
No
If necessary, are you willing to attend obedience classes at your expense?
Yes
No
Under what circumstances would you not keep the dog? Click ALL that apply:
*
Divorce
Family illness
Moving
New baby
Dog got too big
New job
Chewing
Kids ignore
Shedding
Medical bills
Allergy
Not obedient
Housetraining problem
Pets don't get along
Biting
Barking
Digging
None
Explain
What would you do if the dog grew to be bigger than you expected?
Return to the rescue group
Take to a shelter
Take to dog pound
Give away
Nothing
Explain
A dog may live 15+ years. What would you do with your dog if you could no longer care for it?
Additional Information
Is there anything else you would like to tell us about yourself or your home environment?
Have you or any member of your household been investigated, arrested, charged or convicted of animal abuse or neglect? If yes, please explain.
Yes
No
Explain
I desire to adopt the pet listed on this application. I understand, agree and represent:
I understand this is an application only and MCAP has the sole discretion, with or without cause, to accept or decline this application:
Yes
No
I understand there is an adoption fee associated with an adoption to cover MCAP expenses for caring for the dog or cat prior to adoption?
Yes
No
I understand there is a transport fee associated with transportation to cover MCAP expenses for arranging and transporting the dog or cat from Mississippi to new home out-of-state?
Yes
No
If any of the information changes I will advise MCAP promptly?
Yes
No
Digital Signature
All of the information I have provided in this application is true and correct. Any false or misleading information may be grounds for denying the application or for the recovery of the pet at MCAP' sole discretion. Your digital signature is required to confirm your understanding of all the terms and conditions stated here. Enter your birthday to affirm our digital signature (example: January 1, 1950). If you prefer not to digitally sign the application, you will be required to physically sign the application to complete the adoption process. Thank you.
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