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Adoption Application

All fields are required.

Contact Information

First Name: 
Last Name: 
Primary Telephone: ( ) -
Additional Phones: 
Primary E-mail: 
Additional E-mails: 
   
Street Address: 
City: 
State: 
Zip Code: 

I am interested in
(Name of dog(s). Enter FOSTER HOME if interested in fostering and skip to "Information About Your Home and Pets".)

Please tell us why you want to adopt this specific dog.

What are you adopting the dog for? List all that apply.

Ex: hunting, for children, companionship, mouser, guard dog, farm work, breeding, as a gift, or other reason.

Please tell us about your plans to care for the dog.

Ex: using crates, obedience classes, housebreaking, exercise, shedding.

Where do you plan on keeping the dog you are adopting?

Ex: In the house, in a crate, in an outside kennel, in a barn, in a garage, tied up outside, outside loose, in a fenced yard, or other situation.

How will the dog be left alone when you are away from home?

What will happen to the dog if you move?

How will you transport the dog when needed?

What do you consider is an acceptable reason for giving up a pet?

Information About Your Home and Pets

Do you rent or own?    Type of home?  

If renting, please provide your landlord's name and phone number:

Please list the names and ages of each household member.
Place an asterisk (*) next to the primary caretaker.
Note any known allergies.

Please describe the yard / outside space for your living arrangements.

Please list the pets you have cared for in the past five years.
Include the following: species, name, sex, sterilization, how long you have cared for the pet. If the pet is no longer with you, indicate why.

For each pet currently in your household, please list their vaccination and exam status.

Is there anything else you'd like to tell us about yourself?

Are you financially prepared to afford the veterinary fees ($300+/yr) and unexpected costs such as ear infections, upper respiratory infections or parasites that can cost anywhere from $100-300 to treat?

References

Please include the name and phone number (and e-mail address if available) of two references and your veterinarian. Please notify your references before they are contacted!

Veterinarian

Reference #1

Reference #2

Agreement

By signing below with my initials I certify that all the above information is true to the best of my knowledge and I recognize that any misrepresentation will result in the loss of adoption privileges. I authorize investigation of all statements in this application and understand that the Veterinarians, other shelters, Landlords, ect. may be contacted. I also understand that the approval of this application can take time, which will allow me time to reconsider my lifelong commitment to the animal that I have selected.

I also understand that by initialing below the undersigned acknowledges that the Premises of the Foster Home (Agent) of Madison Mutts (SHSS), and the animals, guests, items and activities thereon, pose potential dangers to people and animals. Such dangers include, by way of example and not limitation, animals that can bite, scratch, trip, knock down, and fight, indoor and outdoor surfaces that may be slippery, equipment that can trip, persons who cannot control their dogs, and activities involving dogs that can result in injury from bites or other causes. Accordingly, Undersigned, on behalf of him/her, his/her spouse and minor children, and anyone else whom Undersigned brings onto the Premises of the Owner or Occupier, (a) waives any and all legal duties on the part of the Agent of SHSS to keep the Premises free of dangers and defects, and to warn of any of the same, and (b) releases Agent of SHSS from and assumes the risk of injuries, losses, damages, costs and expenses by any means above described, and other injuries, losses, damages, costs and expenses of every possible cause and description unless inflicted intentionally or recklessly by the Agents of SHSS.

If you are serious about adopting, please be ready to adopt within 5-7 days. We will move onto the next application if you are unable to meet the dog you are applying for in a timely matter. We also ask that all members of the family come to meet the dog you are interested in, if possible.

Madison Mutts reserves the right to refuse any application, without explanation.

Enter Your Initials:
This is your signature.