Adoption Application

Adoption Application

The Michael Movement 501(c)3
Contact Information
Name*

First NameLast Name
Today's Date*

MonthDayYear
Date
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Occupation*
Family and Housing
Do you own your home?*

YesNo, I rent
If you Rent, do you have Landlord permission to have an animal?*
Landlord Name*

First NameLast Name
Landlord Contact Number (by providing this information, you are allowing us to contact your Landlord)*
Please enter a valid phone number.
How many adults live in your home?*
How many children live in your home? What are their ages? *
Type of home*

Single FamilyTownhomeApartment/CondoMobile home
Does everyone in the house agree to an animal?*
Does anyone have allergies to particular animals?*
How would you describe your household?*

Active/energeticNoisyCalm/quietAverage
Does your household have the time and energy to give to an animal?*
How to you plan to exercise your dog? How often and for how long?*
Other Pets
List all pets currently in home (species, gender, age)*
Are these pets current on vaccinations?*
Are these pets spayed/neutered? If not, why?*
Have you ever surrendered a pet? If yes, why?*
Have you ever had a pet euthanized? If yes, why?*
Have you ever lost a pet to an accident?*
What is your training style?*
How and why do you discipline your animals?*
Veterinarian
Do you have a regular Veterinarian?*

YesNo
Veterinarian Name

First NameLast Name
Clinic Name
Clinic Phone Number
Please enter a valid phone number.
Clinic Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
About the Animal you wish to Adopt
Animal Name
Why would you like to add this animal to your family?*
Type of animal you are willing to adopt (Check all that apply)*

EnergeticMedical needsRegular groomingShyNeeds trainingNeeds regular activityNone of the above
Where will this animal spend most of the day? Describe*
Where will this animal spend the night? Describe*
How many hours a day will this animal be alone?*
Who will be the primary caregiver of this animal?*
Who is financially responsible for this animal? *
Do you agree to provide regular veterinary care?*

YesNo
Will this animal be an indoor animal?*

YesNo
Do you have a fenced yard? If not, how do you plan to contain this animal safely outside?*
Do you agree to return the animal to The Michael Movement if you can no longer care for it?*
Are you aware and prepared for medical emergencies that can become expensive?*
References
Reference #1*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Relationship to you*
Reference #2*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Relationship to you*
Reference #3*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Relationship to you*
If this placement does not work out, for any reason, I agree to return my adopted animal to The Michael Movement.
Signature
Disclaimer

I understand all of the above information to be true and correct. From hereon, The Michael Movement, it's agents, volunteers, employees, Board of Directors, officers and representatives are hereby referred to as The Michael Movement. I give The Michael Movement permission to contact listed parties including: Landlords, Veterinarians and References. This animal will reside in my home as a pet. I will provide it with quality food, plenty of fresh water, indoor shelter, affection, annual physical examination and vaccinations under the supervision of a licensed Veterinarian. I understand animals can be unpredictable and hereby agree to indemnify and hold harmless The Michael Movement for any behavior, losses, claims, fines, injuries, damages or other actions of the animal I take possession of. I release The Michael Movement of all liability, both financial and otherwise to the fullest extent of the law. I understand the above statements and agree by signing below.
Signature*
Date*

MonthDayYear
Date
Should be Empty:

Adoption Application

Contact Information

Family and Housing

Other Pets

Veterinarian

About the Animal you wish to Adopt

References

Disclaimer