Dog Rescue Application Form
Apply to adopt a dog from Madison To The Rescue. Please complete all sections accurately. Required fields are marked.
Madison To The Rescue, LLC Application Form
Name of dog you are interested in
*
Name
*
First Name
Last Name
Street address
*
City/State/Zip
*
Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Occupation
*
How long at current job
*
Do you live in a(n)?
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House
Townhouse
Apartment/Condo
Other
Your home is:
*
Owned, by you or your spouse/life partner
Rented directly from the owner or through a management company
If renting, do you have your landlordʼs permission to have a dog?
*
YES
NO
Please list all occupants of your home including yourself, their ages, and their relationship to you:
*
How would you describe your dog owning experience?
*
I have had dogs of my own as an adult
I grew up with dogs or have worked with them but have not had my own as an adult
I have never had one or have limited experience with dogs
Other
Have you adopted a pet before?
*
Why are you interested in adopting a pet at this time?
*
Do you currently have pets?
*
YES
NO
If yes, please complete the following for each pet:
How many hours will your pet be alone each day?
*
Where will your dog spend most of his/her day when you are home?
*
indoors
garage
yard
enclosed patio
indoor/outdoor
other
Where will the dog stay when he/she is home alone?
*
indoor/outdoor (doggy-door)
run of the house
crate
inside only (specify)
yard
garage
enclosed patio
outside only (specify)
other
Where will the dog sleep at night?
*
indoor/outdoor (doggy-door)
run of the house
crate
inside only (specify)
outside only (specify)
Do you have a yard?
*
If you have pets, how do you think they will adjust to a new dog in the house?
*
Have you had experience with behavioral or medical issues with your previous or current pets? If yes, please describe:
*
Pets are an investment of your time and money. Can you afford to provide medical care, grooming, proper diet, shelter, and exercise for your new dog?
*
YES
NO
What is your estimated monthly budget for your dog?
*
Are you able to make a long-term commitment to care for your pet for its entire life span, which could be as long as 15 years or more?
*
YES
NO
Who is your veterinarian (name and phone)?
*
If you move, what will you do with your dog?
*
Which of the following reasons might force you to give up your dog? (Check all that apply):
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excessive barking/neighbor complaints
aggressive on leash
destructive chewing
biting/aggression
digging
shedding/dirty
not trainable
allergies
moving/relocating
house-training problems
growling at guests
excessive vet bills/chronic illness
having a baby
nips or bites children
new spouse/partner doesn’t like dogs
pets aren’t getting along
None of the above
other
Do you understand there is an adjustment period that's roughly around 3 months for a newly adopted dog?
*
Do you agree to let us help you work with your pet through this adjustment period?
*
When are you looking/ready to bring home your new pet?
*
We cannot guarantee breed, we list the breed as estimated by our veterinarian/shelter, these animals are rescued animals. Our best guess on the breed is that - a guess. We are not breeders, we do not perform DNA tests on these animals. Please confirm you are ok with that.
*
Personal Reference (Name & Phone Number)
*
Adopter’s Printed Name
*
Adopter’s Signature
*
Date (Adopter)
*
-
Month
-
Day
Year
Date
Submit Application
Submit Application
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