Adoption Application - Mikaela's Mutt Motel

First Name *

Last Name *

Phone *

Email Address *

Is there a second adopter? *YesNo

First Name *

Last Name *

Phone *

Email Address *

Other household members: *Please include names, ages, and relationship. Enter "N/A" if there are none.

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Eldest Adopter's Date of Birth *

Over 21? *YesNo

Are any household members under 18 years of age? *YesNo

How soon do you want to adopt? *

Do you own or rent your home? *OwnRent

Landlord/Property Management Information

Name *

Phone *

Email Address *

How did you hear about us?

Which dog(s) are you currently interested in? *

What size dog(s) are you interest in? *SmallMediumLargeX-Large

What energy level are you interested in? *Couch PotatoMildEnergeticMarathon Runner

Why are you interested in a new dog(s) and how will you incorporate the new dog(s) into your existing family/lifestyle? *

How will your new dog(s) get exercise/play? *

Do you have a fenced-in yard? *YesNo

Where will your new dog(s) stay when you are away from home? *CratedConfined area of the homeLoose in the homeOutside

What is the maximum amount of time your new dog(s) will stay home alone? *

How do you plan to care for the new dog(s) while on vacation? *

Are you willing to seek professional training for any pet behavior issues? Why / Why not? *Free and/or discounted training services may be available from our training partner.

What might cause you to surrender/re-home your pet? *

Are there any pets in the house that belong to someone else? *YesNo

Have you owned any pets in the past 10 years? *YesNoPlease include pets in the house that do not belong to you.

Please list all pets owned in the past 10 years and where they are now: *Please include pets that live in the home but do not belong to you.

Are all pets in the house spayed/neutered? *YesNo

Please explain why all pets in the house are not spayed/neutered. *

Are all pets in the home up-to-date on DHPP Vaccination? *YesNo

Are all pets in the home up-to-date on Rabies Vaccination? *YesNo

Are all pets in the home up-to-date on Bordetella Vaccination? *YesNo

Are all pets in the home up-to-date on Heartworm Preventative? *YesNo

Are all pets in the home up-to-date on Flea/Tick Preventative? *YesNo

Please explain why your pet(s) is/are not up-to-date on all of the above: *

Please provide contact information for the veterinarian who has seen your pets or who you plan to use for your new dog(s):

Clinic Name *

Phone *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Please note, references shall not be related by blood or marriage nor shall they reside in the same household as the applicant(s).

Reference #1

Name *

Phone *

Email Address *

Relation: *

Best time to contact: *

Reference #2

Name *

Phone *

Email Address *

Relation: *

Best time to contact: *

Reference #3

Name *

Phone *

Email Address *

Relation: *

Best time to contact: *

Name *

Date *