Small Animal Adoption Application

Contact Information

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Household Information

Do you

Own

Rent

If renting, any pet restrictions?

If renting, landlord contact information

What type of home do you live in?

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?

My Home Environment

What size and enclosure type will your pet have?

Who will be the primary care taker?

What type of bedding will you use?

Do you understand their nutrition requirements? Please explain.

How much time on average will you dedicate to care of your animal a day?

If I move, my plan for my pet is:

Why do you want this type of pet?

What is your enrichment plan for them?

What type of training do you plan?

It’s most important to me that my that?

What would cause you to give up this pet?

What is your plan if they needed unexpected vet care

Do you agree to not breed your pet

Do you agree to surrender the animal 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 Or planned local exotic Vet

First Name

Last Name

1st Non-relative reference

First Name

Last Name

Relationship and How long known

2nd Non-relative reference

First Name

Last Name

Relationship and How long known

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