Dog Adoption Application | Melt My Heart Rescue

Dog Adoption Application

Contact Information

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Phone/Mobile

Household Information

Do you

Own

Rent

If renting, any pet restrictions?

If renting, landlord contact information

Do you live in

Is there a yard?

Is the yard fenced?

If yes, how high? What kind?

How many people in your household?

Ages of children under 18, if any?

Do children regularly visit your home?

Are you over 18?

Occupation?

Do your pets get regular vet check-ups?

Are your pets current on vaccines?

If not current on vaccines, why?

Do you use flea and tick preventative?

Current Pets

TYPE AND BREED OF PET	AGE	GENDER	ALTERED? (If not, why?)	Kept inside, outside or both?	How long lived with you?

Previous Pets

TYPE AND BREED OF PET	How long lived with you?	Reason no longer living with you?

My Home Environment

Activity level in my household is

Low

Medium

High

Activity level in my neighborhood is

Quiet and rural

Somewhat active/Suburban

Busy/Urban

On average, my home will be without people ____ hours a day ____ days a week?

When home alone, my dog will be...

My dog will sleep in _______________

I can spend ____ hours a day exercising my dog?

If I move, my plan for my pet is:

My exercise plan for my dog:

My training plan for my dog:

It’s most important to me that my dog

What would cause you to give up a dog

What is your plan if the dog needed unexpected vet care

Do you agree to surrender your dog back to MMHRS in the event you no longer can care for them, or provide them with new owner contact and opportunity to approve new owner?

References

Current Veterinarian

First Name

Last Name

Phone/Mobile

*Please let the vet know to authorize us to call and discuss with your vet and ensure your pets are up to date on neuter/spay and vaccines*

1st Non-relative reference

First Name

Last Name

Phone/Mobile

Relationship and How long known

2nd Non-relative reference

First Name

Last Name

Phone/Mobile

Relationship and How long known

*3rd Reference may be Kitsap Humane Society*

I consent to having this website store my submitted information so they can respond to my inquiry

I have read and understand the above application and have filled out this form honestly to the best of my ability and certify the above true and am in agreement with the above