Application Form To Adopt

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState

Postal / Zip Code

Email*

example@example.com

Phone Number (mobile or landline) *

Have you joined our facebook page?*

What is your social media name*

Instagram name:*

Occupation*

Do you currently own a dog(s)*

If you answered yes,please list your dog(s) details. Breed,age,sex,if neutered *

Is you dog(s) happy to share and welcome another dog into there home?*

When was the last time a dog came into you home? How did you introduce them?*

Have you ever surrendered a dog?*

YesNo

If you answered yes please state reason why?*

Have you ever had to get advise off a behaviourist due to resident dogs? Also state reason a behaviourist was required*

Is you property*

OwnedRented

If rented we will require tenancy agreement from landlord stating you are allowed a dog. please send details to midlandscleftrescue@gmail.com *

Property type*

Do you have garden access? *

Is garden secure?*

Please list names,ages,occupations and hours worked of ALL occupants in household.*

How many hours a day will dog be left?*

Where will dog sleep and be left when out?*

Do you children visit you home? *

Please state age of visiting children*

Why are you wanting to adopt from MCR? *

Have you ever owned a cleft dog or medical dog?*

Which pup are you Interested in?*

We will also require videos of your home if successful.This is to include a video of you going into the home showing us the number of house.A video of round the house.Video of garden showing full boundaries.The safety of our pups will always come first 🐾*

I agree

I give my consent for Midlands Cleft Rescue to Gather, process and store my personal data, Use my personal data in decision making relating to adoption of a dog, I understand that I may withdraw my consent at any point.*

I agree

DECLARATION: that the information I have supplied in this application is accurate to the best of my knowledge.*

I agree

All MCR pups leave fully health checked by our vet. Vaccinated,Microchiped and Neutering contract in place.Adoption fee £550*

Have acknowledged

Thank you for choosing to adopt a special furbabie from MCR❤️