EmailMe Form - Application to Adopt Special

Please list the name of the dog you’re interested in and tell us why you’re interested in this particular dog. If you don't have a preference, please indicate puppy or adult or any. Thank you!

Date *

MM / DD / YYYY

Your Name

First Last

Age

Occupation

Spouse/Significant Other Name

First Last

Age

Occupation

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone

### - ### - ####

Email

Please list anyone else living in the home (children.roommates,family etc with ages)

Type of dwelling:: House, Condo, Apt, Other

Do you Rent or Own?

If renting, do you have your landlord’s permission to have the type of dog you want to adopt?

Landlord’s name and phone number:

What are your primary reasons for wanting a dog? Companion for you, For your kids, Gift, For other pet, Watchdog, Other (please explain)

If you have children, please describe their previous experience with dogs

Does anyone in your household have allergies?
If yes, describe

Do you have any pets now? How Many?

Type of Pets (if dog, list breed): Ages:. Sex(es): Other Pets:

Are your pet/s spayed/neutered?

Is there anybody home during the day? Who?

When will the dog be inside? Outside?

About how many hours will the dog be left alone?
Where will the dog stay when he/she is home alone? (please be as specific as possible; i.e. run of the house, a specific room, a crate, etc.)

Where will the dog sleep at night? Dog House, Garage, Inside: If inside, where exactly? Kitchen,, Master bedroom, Spare Room, Laundry Room, Run of the house, Other: If other or if you have additional comments on where the dog will sleep, please specify:

What rooms are off limits to the dog?

What outside areas are available to the dog? Fenced yard Enclosed Patio Garage. Dog House Unfenced common area Other (Not having a fenced yard does not automatically disqualify you as an adopter)

Do you have a doggie door?

Type of fencing? (Chain link, wood, block wall, etc.)
Height of Fence? __Highest Point. __Lowest Point

I have recently inspected my fences and its in good condition. Yes or No

The fence is intact on all sides and is at least 6 feet from the ground level in all areas. Yes or No

I promise to inspect my fences thoroughly before the home visit and make necessary repairs for the safety and well being of our new Pet. Yes or No

Are there gate? Yes or No
How many gates?
How High?__ft.
Is there any type of lock on the gate(s)? Yes or No Type of lock if yes (padlock, key, latch, etc.)
If no locks, would you be willing to install them prior to placement should this application be accepted? Yes or No

Who has access to your yard? Gardner. Pool man. Utility. Neighbor. Other, please explain:

Preferred level of exercise with dog: Couch potato. Short walks. Vigorous walks. Hike or jog regularly.

When you go on vacation, who will care for the dog? (friend, kennel, dog sitter, etc.)

What kind of quality dog food will you feed your dog?

Do you have a regular vet? Yes or No

If yes,
Name:
Address:
Phone:

Would you like a referral to a vet? Yes or No

Who will groom and bathe your dog?

Would your dog wear a collar? Yes or No
When?

Would you allow your dog to wear an I.D. Tag? Yes or No

How would you rate your level of dog owning experience?
First time owner.
Beginner.
Intermediate.
Advanced

How would you discipline your dog if he or she misbehaved?

How would you train this dog?
Obedience class.
Hit with newspaper.
Firm verbal commands.
Clicker/ hand signals.
Other, Explain__________________

How do you normally walk your dog? On leash. Off leash
When on leash do you normally use? Collar only. Corrective collar. Harness.

Are you willing to live with hair on the furniture, stains on your rugs, a warm body on your bed, and an animal that might be destructive at times. Yes or No

Pets are an investment of your time and money. Can you afford to provide medical care, grooming, proper diet, shelter, and exercise for your new pet? Yes or No

Are you able to make a long-term commitment to care for your pet for its entire life span, which could be as much as 10 to 20 years? Yes or No

What would happen to your pets if you moved?
Locally?
Out of State?
Out of the Country?

Which of the following reasons might prompt you to give up your dog? (List all that apply):
Excessive barking
Biting
Digging
Moviing
Divorce
Poor watchdog
Destructive chewing
Financial Problems
Occasional accidents indoors
Growling at guests
Excessive vet bills
Shedding
Allergies
New Spouse/ partner doesn’t like dogs
Aggressive on leash
None of the above
Comments

Please list pets you have owned since you have been an adult and the length of ownership; if they are no longer with you, please provide an explanation:

Two Personal References not living with you:
Name:
Address:
Phone:
Length of time known:
Name:
Address:
Phone:
Length of time known: *

How did you find out about our adoption program?

Why are you interested in adopting from a rescue?

Please read and initial each statement bellow: *

I understand that a home visit is required prior to final placement

Please read and initial each statement bellow: *

I CAN give a non-tax-deductible gift of at least $150 to help rescue, provide medical care, spay, and neuter, board and place other abandoned dogs. This is the only cost to adopt your dog.

Please read and initial each statement bellow: *

I understand that a home visit does not guarantee placement

Please read and initial each statement bellow: *

I agree to provide my own collar, leash, corrective collar or harness, and a personal ID tag at the time of completing the adoption contract

I, Meaza Ridley with JMM Rescue reserve the right to refuse adoption to any applicant for any reason. This questionnaire becomes part of our contract. MSR

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