Application Form To Adopt

Who are you applying 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) *

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) breed, age, sex and if neutered. *

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

When was the last time a dog came into your 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 your property*

OwnedRented

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 young children visit your home (how old if so)? *

Why are you wanting to adopt from MCR? *

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

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, with minimum first vaccinations, microchipped and a neutering contract in place. Adoption fee is £550*

Have acknowledged

If successful in the application process, we will message you to ask for a homecheck video (requesting all rooms within the home and the garden). Please do not send this unless requested.

Have acknowledged

Thank you for choosing to apply for one of our special pups from Midlands Cleft Rescue