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Adoption Application

Personal Information:
First Name _______________________ Last Name ______________________ Occupation_______________________

Spouses Name ____________________ Last Name ______________________ Occupation______________________


Address___________________________________________________________________________________________
City __________________________ State_______ Zip______________ Email __________________________________
Home Phone ___________________________ Cell phone __________________________________

Do you have children? ___Yes ___No (If yes, please provide their names and ages)
Name __________________________

Age ________

Name __________________________ Age _________

Name __________________________ Age _________ Name __________________________

Age _________

Have your children lived with or had exposure to dogs? ___Yes ___No

Residence Information:
___House ___Apartment
__
Fence Type ___

___Own? ___Rent? Fenced yard? ___Yes ___No


_

_____

Fence Height _______

Fully Enclosed? ___Yes ___No

If Rent, please provide lease or written approval from Landlord.


Landlord Name_____________________________________________ Landlord Phone # _______________________

Pet Information:
Dog #1
Name ________________________________ Breed _______________________________ Age________
Spayed or Neutered? ___Yes ___No

If no, please list reasons:__________________________________________

Up-to-date on vaccinations? ___Yes ___ No

Friendly with other dogs?___Yes ___No

Dog # 2
Name ________________________________ Breed _______________________________ Age________
Spayed or Neutered? ___Yes ___No If no, please list
reasons:__________________________________________
Up-to-date on vaccinations? ___Yes ___ No

Friendly with other dogs?___Yes ___No

Dog #3
Name ________________________________ Breed _______________________________ Age________
Spayed or Neutered? ___Yes ___No If no, please list
reasons:__________________________________________
Up-to-date on vaccinations? ___Yes ___ No

Friendly with other dogs?___Yes ___No

Other Pet #4
Name ___________________
Age________

__ Species/Breed ____

______________

Spayed or Neutered? ___Yes ___No If no, please list reasons:___________________________


_______________
Up-to-date on vaccinations? ___Yes ___No

Friendly with other dogs? ___Yes ___No

Other Pet #5
Name ________________

___ __ Species/Breed _____

Spayed or Neutered? ___Yes ___No


__________________

_______

______ Age________

If no, please list reasons:______________________

Up-to-date on vaccinations? ___Yes ___No

Friendly with other dogs? ___Yes ___No

How long are your dog(s) left alone during the day?
_______________________________________________________
Where do the dogs stay when youre not at home?
_______________________________________________________
Do you crate your dog(s)? ___Yes ___No

Do you plan on crating your new dog? ___Yes ___No

Past Pet Information: Please list any pets youve owned in the last 5 years (please include their
breed, name and age
__________________________________________________________________________________________________

Why do you no longer have them?


__________________________________________________________________________________________________

Veterinarian Information:
Clinic Name____________________________
_________________________
Vets Name______________________________________

Phone # ________________________________

Personal Reference (Non-related):


Reference #1
First Name _____________________________ Last Name ___________________________________
Home Phone _______________________

Cell phone __________________________________

How long have you known this person?___________________________ Relationship


____________________________

Reference #2
First Name _____________________________ Last Name ___________________________________
Home Phone _______________________

Cell phone __________________________________

How long have you known this person?___________________________ Relationship


____________________________

By signing this document I certify that all information provided on this application is truthful. I
give permission to Mighty Mutts Rescue, Inc. to verify information given if necessary, including
medical information from my Veterinarian. Any falsifying of information will terminate the
potential adoption. Mighty Mutts Rescue, Inc. reserves the right to deny adoption for any reason
without explanation. If approved this application becomes part of the adoption contract.

_________________________________
Signature

Date

________________________________

_________________________________
Signature

Date

________________________________

For Mighty Mutts Rescue Use Only:


Vet reference:
____________________________________________________________________________________
________________________________________________________________________________________________
Application Approved: Yes ________ No _________
If no, list why:
____________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
_________________________________
Volunteer Signature

________________________________
Date