Dog Adoption Application

Miles To Freedom Animal Rescue

Maine Shelter License # F-1831
Dog Adoption Application
This adoption application is designed to help Miles To Freedom and yourself 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.
Applicant Information
Name of the Dog you are applying for:*
If the dog you are applying for is not available, do you want us to contact you with other options?*

YesNo
Your Full Name:*
Your Date of Birth:*
Drivers License Issuing State:*
Drivers License Number:*
Physical Address:*

Street Address

Street Address Line 2

CityState

Zip Code
How Long Have You Lived At The Above Address:*
Mailing Address (if different than physical)

Street Address or PO Box

CityState

Zip Code
Home Phone:*
Please enter a valid phone number.
Cell Phone:*
Please enter a valid phone number.
Email:*
example@example.com
Employer:*
How long have you been employed here:*
Employer Phone Number:*
Please enter a valid phone number.
CO-ADOPTER INFORMATION
Co-Adopters/Spouse/Significant Others Name:*

First NameLast Name
Co-Adopters Date of Birth:*
Co-Adopters Phone Number*
Please enter a valid phone number.
Co-Adopter Drivers License State and #*
PLEASE PROVIDE TWO (2) REFERENCES THAT ARE NOT MEMBERS OF YOUR IMMEDIATE FAMILY
Personal Reference #1:*
Personal Reference #1 Phone Number:*
Personal Reference #1 Relationship to you:*
Personal Reference #1 Years known:*
Personal Reference #2:*
Personal Reference #2 Phone Number:*
Personal Reference #2 Relationship to you:*
Personal Reference #2 Years known:*
ABOUT YOUR HOME
Who will be the pets primary care giver?*
Are all members of your household in agreement with this adoption?*

YesNo
Did you live in a(n):*

HouseApartmentTownhouse/Condo
Your home is:*

Owned, by you or your spouse/life partnerOwned, by someone else within the houseRented directly from the owner or through a management companRented as part of a group of roomatesOther
If renting, is your name on the lease?

YesNo
If renting, do you have landlord permission to have a dog?

YesNo
Please Provide Name of Landlord:
Please Provide Landlord Phone Number:
Who shares your household (please check all that apply):*

I live aloneSpouse/Life PartnerBoyfriend/GirlfriendRoomate(s)Other
Are there any children in the home?*

YesNo
If yes, how many?
If yes, what are their ages?
If yes, have your children been around animals before?

YesNo
If there are children, please explain their experience with dogs:
If your present relationship/living situation were to change and you were no longer able to care for the dog, a new application must be submitted and approved in order to transfer ownership, or the dog is to be returned to Miles To Freedom. Do you understand? **

YesNo
Do you have plans to move soon?*

YesNo
If yes, What is your plan for your pets?
Does anyone in your household have an allergy to dogs that you are aware of?*

YesNo
Is someone home during the day?*

YesNo
If yes, Who?*
Where will your dog spend most of his/her day?*

IndoorsYardKennelIndoor/outdoor (doggy door with fenced yard)GarageOther
How many hours per day will your dog be alone?*
Where will your dog stay when he/she is home alone?*

Loose in the houseKennel/Crate in the houseIndoor/outdoor (doggy door with fenced yard)Outside only (on a run)Outside only (loose in the yard)Other
Where will the dog sleep at night?*
What outside areas are available to the dog? (check all that apply)*

Front yardBack yardDog houseGarageDog runOther
Do you have a doggy Door?*

YesNo
Is your yard shared with your neighbor?*

YesNo
Do you have a fully fenced yard?*

YesNo
If yes, what is the height and type of fence?
If yes, have you inspected your fence recently to ensure in good working order?

YesNo
CURRENT AND PREVIOUS PET INFORMATION
How would you describe your dog owning experience?*

I have had dogs of my own as an adultI grew up with dogs or have worked with them but have not owned them as an adultI have never owned a dogOther
How many dogs have you owned in the last 5 years?*
Where are they now, and/or what happened to the other dog(s)?*
Have you ever given up a pet?*

YesNo
If yes, what were the circumstances?*
Which of the following circumstance might force you to give up your dog? (check all that apply)*

Excessive barking/neighbor complaintsBiting/AggressionShedding/DirtyHouse training problemsExcessive vet bills/chronic illnessNew spouse/Partner doesn't like dogsDigging in the yardNot trainableFinancial problemsPets are not getting alongHaving a babyAggression on leashDestructive chewingDivorce/SeparationAllergiesPoor watchdogMoving/RelocatingGrowling/Nipping at guestsNips or bites at childrenNone of the aboveOther
Do you have pets currently?*

YesNo

If yes, please list all current pet information here:

	Type (dog or cat)	Name	Breed	Gender	Age	Spayed/Neutered	If not spayed/neutered, Why?
Pet 1
Pet 2
Pet 3
Pet 4
Pet 5
Pet 6
Pet 7
Pet 8
Pet 9
Pet 10

Who do you use for a Veterinary Practice?*
What is their address:*
What is their phone number?*
Have you called your vet to release information to us to process your Veterinary Reference? ****PLEASE NOTE**** This must be done for us to move forward with your application!*

YesNoN/A
How do you feel your current pets will adjust to a new dog in the house?
Have you had experience with behavioral or medical issues with any of your previous pets?*

NoBehavioralMedical
If behavioral or medical, please explain:
Share your reasons for wanting to adopt a dog? (check all that apply)*

Family PetCompanionGift for someoneChilds companionProtection/Guard dogCompanion for another petOther
Are you aware that dog aggression issues can be present in any breed?*

YesNo
How are you prepared to handle/address these issues should they arise? Please be specific*
Would you be willing to seek professional training if issues arise?*

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

YesNo
What methods of house training do you intend to use? (select all that apply)*

Rub nose in offending spotTake out every couple of hoursCrate trainingConsult a professionalOther
ADDITIONAL INFORMATION
What type of personality are you looking for in your new dog? *
Pets are an investment of your time and money. Are you financially and emotionally able to care for a new dog at this time? (i.e. groom, medical care, proper diet, exercise, shelter and love)*

YesNo
Are you able to make a long-term commitment to care for your new dog? (life span can be 15 years or more)*

YesNo
Please list anything else you would like to share with us that may not be listed above:
PLEASE READ AND AGREE TO EACH STATMENT BELOW:

By selecting the "I understand" or the "I agree" checkbox, this is in place of an initial due to the form being electronic. Please know that if approved for adoption this contract becomes binding to the terms and conditions below.
I understand that a home visit may be required prior to final placement and I agree to allow M2F members to conduct one.*

I understand & AgreeI DO NOT agree
I understand that a home visit does not guarantee placement.*

I understandI DO NOT understand
I agree to provide my own supplies such as collar, leash ID tags at time of completing adoption and picking up my new dog.*

I agreeI DO NOT agree
I understand and agree to, if for any reason at all, I have to give up my dog, I am to notify Miles To Freedom Animal Rescue to relinquish the dog back into their care immediately.*

I understand & AgreeI DO NOT understand
I understand that I assume full responsibility for the welfare of this pet from date of adoption.*

I understandI DO NOT understand
Todays Date*

MonthDayYear
Date (Please note we will adjust this date at the time of Adoption to the finalized adoption date
AM/PM Option
Signature*

Clear
WE RESERVE THE RIGHT TO REFUSE ADOPTION TO ANY APPLICANT FOR ANY REASON. THIS APPLICATION BECOMES PART OF OUR BINDING CONTRACT.
Should be Empty:

Miles To Freedom Animal Rescue

Dog Adoption Application

Applicant Information

CO-ADOPTER INFORMATION

PLEASE PROVIDE TWO (2) REFERENCES THAT ARE NOT MEMBERS OF YOUR IMMEDIATE FAMILY

ABOUT YOUR HOME

CURRENT AND PREVIOUS PET INFORMATION

ADDITIONAL INFORMATION

PLEASE READ AND AGREE TO EACH STATMENT BELOW: