MARQ Adoption Survey
Staff
Name of pet you would like to adopt
If you are interested in a specific breed or breeds we may get in the future, you can list those here.
Your Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
E-mail
*
Phone Number
*
What is your occupation?
*
How long with your current employer?
*
Do you Rent or Own Your Home
*
Rent
Own
Housing Type
*
House
Apartment/Condo
Assisted Living Community
Other
How long have you lived at this residence?
*
How long to you plan to stay at this residence?
What would you with your animals if you had to move?
*
What type of fencing do you have? (Not required in most cases)
*
Do you have a dog door? (not required)
Yes
No
Where will this pet be kept when you're home?
*
Where will this pet be kept when you're gone?
*
List all other people living in your home.
First Name
Age
1.
2.
3.
4.
5.
Is anyone in your home allergic to animals?
*
Yes
No
Name of your vet or vet clinic:
*
This pet will be (mark all that apply)
Companion for self/family
Gift for someone
Inside Pet
Outside Pet
Working Animal (ie hunting, therapy, gaurd)
Other
How much do you expect to spend per year on the care of this pet?
*
What is the activity level of your household?
*
Low
Medium
High
Other
What Are looking for in a new family pet?
*
This animal needs to get along with:
*
Dogs
Cats
Kids under 5
Kids over 5
Just me
Men
Women
Other animals not listed
Tell us about what you are looking for in a new pet.
*
i.g. age, sex, activity level, personality
What concerns, if any, do you have about adopting a new pet?
*
Are there any behaviors this pet could have that would be totally unacceptable to you?
*
How will you correct behavior problems in your dog/cat if they occur?
Tell us about your pet family (other pets you have or have had in the past, age, activity level, personalities).
*
Have you ever given a pet away before, to anyone, for any reason? If so, please tell us about that experience.
*
How many hours will this pet be without human companionship?
*
Please tell us about the animals you've had in the last 5 years (include current pets)
Species
Breed
Male or Female?
Spayed or Neutered?
Age
Still own?
Notes:
1.
2.
3.
4.
5.
6.
That's it! You've reached the end!
* I have read the above information carefully and have filled out this application honestly. I understand that omission of information and/or failure to answer all questions and sign the application can result in this application being declined. Also, if an omission or untruth is discovered after an adoption takes place, I understand that the rescue reserves the right to annul the adoption and reclaim the animal. I give the rescue permission to investigate the information provided, including conducting a background check, as well as contact veterinarians and related officials. I understand the adoption decision is dependent on many factors, including but not limited to the compatibility of the family and home to the individual pet, and other applications received on this pet. I understand it is the rescue sole prerogative to decide which home is most appropriate, that my application can be denied at any time for any reason, that their decision is final and I will not contest it. It is our goal to place pets in loving, lifelong homes and any information gathered is used only to that interest.
*
Yes
No
Other
Submit Form
Should be Empty: