Adoption Application

Name: _____________________________________Spouse:____________________________ Address/City/State/Zip/: _______________________________________________________ Home Number:__________ Work Number:__________Cell Number:_____________ Name of Employer: _____________________________________________________________________ Are you over the age of 18?: _______Yes ______No Email Address:____________________________________________________________________
Own/Rent Your Home? ______________ you have a fenced in Dog Run? ________ ONLY dog? ________________________________ Do you have children at home/how many? _____________ What are their ages? ___________________ Do you currently own any pets? ________ List their names, ages and breeds: _____________________ ____________________________________________________________ Have you ever experienced death of a pet? If youd like tell us your story. ____________________________________________________________________ long have you lived there?________________________ Do you If renting: provide landlords name and telephone number: __________________________________________How Do you have a completely fenced in yard? _____________ Do If you do not have a fenced yard, how do you plan to control your pet outside? __________________Will

you walk with leash and harness? ____________ How will you keep the pet in yard? ____________ Will he/she be an inside, inside/outside or OUTSIDE

Vet Reference: including address and phone number, please. (This is a reference we will check on each potential adoption
application). ______________________________ Are your pets vaccinated? _______ Are your pets on heartworm prevention? ________ _______ If not, why? ________________________ Are other members of your family Are family members allergic to animals? (if so Is the dog going to be a gift for someone? Have your pets been spayed/neutered?

aware that you want to adopt a dog? ____________ who)______________________________________

_________________________________________ other)______________________

How did you hear about us? (Internet, newspaper, TV, Radio, Please let us know what you are looking for in a pet OR the name of our rescue dog you

are interested in (size/sex/age/breed) and why: _________________________________________________

Please describe what a typical day will be like for your new dog:
_____________________________________________________________________________________________

Where will the dog spend Where will the dog

the day and how much time alone?__________________

____________________

If you plan to kennel the dog, how many hours per day?

How do you plan to exercise the dog and how often? __________________

sleep at night? _____________________________________

Name any behaviors would you think unacceptable in your dog? Examples:
training and accidents in the house, food issues, growling/barking or skittishness- just to name a few)

(Chewing on all nature of things, tearing up towels

and pee-pee pads, intentionally spilling water/food bowls, tearing up shoes/socks, and all nature of things that are from boredom, mistakes with house

______________________________________________________________________________ List your plan for correcting unacceptable behaviors? ______________________________________________________________________________

List at least 2 references - Include name, address, and telephone number: (these will be checked prior to adoption
being granted) #1.) ___________________________ #2.)_________________________

How did you hear about MASH? _________Facebook _____WebSite _______Adoption Event _____AdoptAPet

______From a Friend _______PetFinder.Com

**Thank you for your interest in one of our rescue dogs! Many of our dogs were saved from less than ideal circumstances and therefore we want only
the best for them in their new forever homes. Our adoption process is thorough. Your answers will be reviewed and your vet and personal references will be contacted. We will contact you by phone as quickly as we can after application review. Please remember we deal with a high volume of calls and applications. We, the adoptive family, agree to provide a safe home for _______________ where he/she will be treated as a family member. We acknowledge that dogs require annual vet visits, vaccinations, dental care, and additional attention if ill. We agree to keep __________ on monthly heartworm, flea and tick preventative as directed by the vet; as well as keeping an ID tag with name and phone number on the dog at all times. We agree to transfer the microchip information into our name, if applicable. We have been informed that the dog is a rescue dog and M.A.S.H does not know the previous health history other than the results on the current records. We will not hold M.A.S.H or any of its representatives responsible for future bills. We will not hold M.A.S.H or any volunteer member liable for problems resulting from the rescued animals behavior.

**Your adoption donation fee goes to pay vet costs of all our dogs for adoption and those being saved from local shelters. All proceeds are spent on the rescue dogs because we are a volunteer group. The adoption donation fee is nonrefundable.

Signature of the adoptive family: _________________________________ Signature of representative of M.A.S.H.: __________________________

Date: ___________ Date: __________

Thank you for giving a second chance to a rescued Dog!