Mississippi English Bulldog Rescue

Full Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Cell Phone Number

Phone Number

Area CodePhone Number

E-mail

Occupation, length of employment,address and phone number

What dog are you interested in adopting?

What type of housing do you reside in?

How long have you been at your current address?

If renting do you have permission to have a pet or multiple pets?List landlords name and address.

Please list all children under 18 that live or frequently visit in the home and their ages.

Do any of the children have special needs?

Do any frequent visitors use a cane, walker, or a wheelchair?

Please list all adults that live or frequently visit the home.

Has anyone in your home or anyone that frequently visits your home been charged with animal cruelty?

Do any children or adults that live in the home have any type of allergies?

Where would the new dog be kept during the day? Where would new dog be kept at night?

Do you have a backyard? Is your back yard fenced? How high is the fence? What type of fence is it?

Does you current home have a pool? Is the pool area fenced?

Please list ALL animals you curently own and their approximate age. This includes dogs, cats,chickens, goats, birds, lizards,guinea pigs, or livestock.

Are all your pets spayed/neutered and up to date on shots, including rabies?

Are any of your pets dominate in any way or food aggressive?

Have you owned any other pets in the past 5 years?

Have you ever had a pet euthanized?

Have you ever had a pet that you had to rehome, one that ran away, or one that was stolen?

Have you ever given away an animal or taken an animal to the "shelter or humane society?'

Have you ever bred any type animal?

Would you be willing to work with a dog that was not completely housebroken?

Have you ever potty trained a dog?

Would you be willing to provide and give daily meds to a new dog if needed?

Have you ever kept a dog on a chain or outside in a pen?

If you decide to have children or move what will you do with your new dog?

Please list you veterinrian name and number and pet name that was treated at said vet.

Please list TWO personal references, name and a number that is not a family member.

List one personal reference that is a family member.

Why are you choosing to adopt?

We feel like it is important to adopt to the best fitting family and dog. Tell us how you would describe your family and how you envision your new dog fitting in.

how many hours will new dog be left alone during the day? where will dog be left during the day?

Where will your dog be kept when you are home?

Where will your dog be allowed to sleep?

Food and nutrition can be tricky with English Bulldogs? What are you plannig to feed your dog? would you bewilling to incur expense of more expensive/or grain free food?

What do you know about heart worms and heart worm meds?

What do you know about immunizations? What do you expect for normal vet bills to be?

When you travel for vacactions, business trips, or weekend trips who will care for your dog?

If there was an accident or illness that required a vet expense of 500 dollars or more what would you do?

How do you feel about barking? How would you deal with barking?

How will you deal with or bowel or bladder accidents?

What behavioral problems would you not be comfortable working with?

Under what circumstances would you feel like you could not keep your new dog?

Will you be willing to update MEBR periodically on adopted dog?

Do you understand that under any circumstances where the dog would have to be rehomed or required extensive medical treatment you would return dog to MEBR rather than rehome or take to shelter?

Mississippi English Bulldog Rescue Adoption Form

About your household...

Your Animals...

Your new dog......

Thank you for applying. You will be notified of our decision.