Adoption Application
Please answer questions thoroughly and honestly so that we can help guide you toward choosing a dog that is a match to your lifestyle. All applicants must be 21 years or older to adopt from Animal Aid of Mississippi. False or missing information will be cause for rejection or void of adoption contract. Please note that completing this application does not commit you to adopting the dog for which you are applying. It serves as a springboard for further conversation on the suitability for your family to adopt a dog within the Animal Aid of Mississippi criteria. INCOMPLETE APPLICATIONS WILL NOT REACH US.
Name of the dog(s) you are applying for.
*
Type "undecided" if not sure yet.
Today's Date
*
-
Month
-
Day
Year
Date
What is your age? (You will be required to show ID to verify)
*
Contact Information
Your Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Work Name and Address
*
About The Adopter
Are you:
*
a student
employed (work outside the home)
employed (work at home)
unemployed
homemaker
Other
How did you first learn about the dog you are interested in and/or Animal Aid of Mississippi?
*
A friend/family
Facebook
Website
Petfinder
Other
What is your reason for wanting to adopt a dog? (Check all that apply)
*
Companion for myself
Companion for Child or Family Member
My pet died recently
Companion for another pet
Emotional support/service animal
Change in living situation that allows pets now
Other
Where will the Dog sleep? (Check all that apply)
*
In a Dog Bed
Outside
In my bed
With another family member
In a crate
On a couch
Other
Housing
Do you live in a
*
House
Apartment
Studio
Condo/Duplex
Mobile/Manufactured home
Rural/Farm
Student Housing
Other
The traffic on my street is:
*
Heavy
Moderate
Light
Other
In regards to your living space, please check one:
*
I own my home
I rent my home
I live in a friend/family member's house
Other
If you are renting, are you permitted to have a Dog on the property?:
*
Yes
No
N/A
Other
Landlord Name
*
Landlord Phone or Email
*
Have you ever needed to rehome a pet?
*
Yes
No
Home Environment and Other Pets
List name and ages of all people in your home:
*
(example: Susan, 44, John 43, Sophie 9)
Tell us about your other CURRENT pets and their spay/neuter status:
*
(example: Pet 1. Male Dog, Dalmation, age 13, likes cats, energetic)
Are your current pets up to date on vaccinations and Heartworm Prevention?
Yes
No
Tell us about your pets owned over the last 5 YEARS that are no longer with you:
*
(example: Pet 1. Male Dog, Dalmation, age 13, likes cats, energetic)
Do you have a current or prior veterinarian? Please write their name and contact information.
*
Have you ever had to rehome a pet? If yes, please explain the circumstances.
*
Choose which options most often describe your home:
*
Quiet
Busy/Noisy
People away most of the day.
People home most of the time.
Is anyone living in your home allergic to Dogs?
*
Yes
No
Other
Care of Your New Dog
How long, on average, will your Dog be alone during the day and where will he/she be kept during this time? (ex: Garage, crate, bedroom, outdoors, free roam inside, free roam outside, etc)
*
What is your exercise plan for your Dog?
*
Do you have a fenced yard? Please describe the containment, if any.
*
If you are on vacation, or away from home for more than 12 hours, who will care for your Dog?
*
Family/Friend/Neighbor
Pet Sitter
Boarding/Kennels
Cat will be self sufficient
Other
Will your Dog be:
*
Indoors only
Outdoors only
Indoor/outdoor with Dog Door
Other
Where will your Dog be kept during the day? (ex: Garage, crate, bedroom, outdoors, free roam inside, free roam outside, etc)
*
Where will your Dog sleep at night? (ex: Garage, bedroom, outdoors, free roam inside, free roam outside, etc)
*
All Dogs shed hair to some extent. How much shedding is acceptable?
*
Light
Moderate
Doesn't Matter
My ideal Dog will:
*
Frequently interact with kids.
Frequently interact with small animals.
Frequently interact with cats.
Frequently interact with other Dogs.
Frequently interact with strangers
Which behaviors would be unacceptable and cause for you to rehome the Dog?
Needs social skills.
Accidents in the house.
Inappropriate chewing.
Digging
Separation anxiety
Jumping
Fighting with other pets
Too much/too little energy
Other
Where will your Dog be kept during the day? (ex: Garage, crate, bedroom, outdoors, free roam inside, free roam outside, etc)
*
In the event that you become incapacitated (ex: inability, illness, injury, death), please explain your care plan for this Dog.
*
If the Dog you are applying for is adopted by someone else, are you interest in speaking with our team about other dogs we have available for adoption? Please describe your "ideal dog."
Thank you for applying.
Your Adoption Application will be reviewed by an Animal Aid Of Mississippi volunteer. Animal Aid reserves the right to deny this application per our discretion. Identification is required during the process of this application. This application becomes part of our Adoption Contract. This adoption application does not commit the applicant unless or until this application becomes an adoption contract.
By signing this application, I hereby certify that the above information is true. I understand that giving false information on this application is grounds for denying my application and voiding any adoption contract. I certify that the dog I am applying for is for me and not for another person. I agree to have all of the information on this document verified and agree to allow Animal Aid of Mississippi to contact my veterinarian, references, and/or landlord, if applicable.
*
I agree.
Signature
*
Save
Submit
Type a question
Should be Empty: