Fred's Mission App

Fred's Mission Rescue & Sanctuary
This questionnaire is designed to help us determine if a specific dog is the right one for you and your household. All adopting parties are required to complete this form prior to adoption.

Fred's Mission Rescue & Sanctuary reserves the right to deny any application based on answers to this questionnaire and/or interviews prior to adoptions!

All pets in the home must be up to date, altered, and have a current heartworm test at the time of the applicaiton. Any exceptions please note in additional comment box.

We do not adopt out to electric fences, tie outs or outside kennels. The dogs are kept in a fenced yard or leashed walked.

Thank you for taking the time to fill out this application!
Name of the dog you are interested in:*
Your full name:*
All pets in the home must be altered, up to date with vaccines and for dogs a current heartworm test. We do verify all vetting for adoption approval.

Pets are fully vettedPets are missing vaccines or heartworm test (please explain at the bottom of the application.
Have you applied for another dog with another rescue in the last 7 days? If the answer is yes, please stop and fill out after those applications have been processed. *
Are you planning on leaving for vacation or work in the next 30 days? If the answer is yes, please stop and fill out the application after your vacation. *
All fields must be completed or the application will not be processed. We do not adopt out to invisible fences, tie outs or outside kennels. *
Applicant Information
Your age:*
Street Address:*
City, State, Zip*
County you pay taxes in
Home Phone:

Area CodePhone Number
Cell Phone:

Area CodePhone Number
E-mail:*
Employer:
Work Phone:

Area CodePhone Number
Household Information
Are all members of your household in agreement with this adoption?*

YesNoDon't Know
Who will be the pet's primary caregiver?*
Do you live in a*

HouseApartmentCondoMobile HomeOther
Do you own or rent?*

OwnRent
If rent, provide name and phone number of landlord:
Does your landlord allow dogs?

YesNo
Are there any restrictions from your landlord or subdivision?*

Number of petsSize or weight restrictionsBreed restrictionsNoneOther
Do you have a fully fenced yard?*

YesNo
Height and type of fence*
Do you have any of the following:*

Electric or underground fenceTie out or zip lineOutside kennelnone
Name, age, and relationship to applicant for everyone over 18 years of age who lives in the home. *
For example: Jane 19 daughter
Please list how many children are in the home full time and their ages:*
If children visit what are their ages and how often do they visit*
Have your children been around animals before?

YesNo
Does anyone in your home have allergies to dogs or have asthma?*

YesNo
What is the activity and energy level in your home?

Laid back/quietAverageBusy all the time
Current/Previous Pet Information
Please list all pets in the last 5 years. Including name of pet, breed, male or female, and age. Please indicate if deceased. *
Where are these animals now?
Have you ever given up a pet?*

YesNo
If yes, what were the circumstances?
Please provide the name and phone number of your current and/or previous veterinarian or clinic. We also must have the account name. *
Have you given the vet permission to release your vet records?*
New Pet Information
What type of personality do you want your pet to have? (i.e. calm, energetic, protective, couch-potato)*
Are you aware of crate training?*

YesNo
Have you ever house-broken a dog or puppy before?*

YesNo
If the dog has an "accident" in your home, what type of correction do you plan to use?*
How many hours each day will your new pet be home alone?*
Where will your new pet sleep at night?*
How will you supervise the dog's outdoor activity?*
Where will your new dog stay when nobody is home?*
What length of time will you allow your new pet to adjust to his new home?*
Are you willing to work through your new pet's issues, if any?*

YesNo
Are you aware that a new environment is stressful for your pet, and they may exhibit uncharacteristic behavior?*

YesNo
Do you understand that a dog can be an 18 year commitment, and can cost $300 - $500 per year to care for?*

YesNo
What circumstances would lead you to give up your new dog?*
If you had to give up your dog, what would you do with him/her?*
Please list two references not related or living with you, their relationship to you, and their phone number:*
Would you allow a home visit prior to approval?*
I understand that I assume full responsibility for the welfare of this pet from the date of adoption.
Additional comments that might assist the processing team.
Should be Empty:

Fred's Mission Rescue & Sanctuary

Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information