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ONLINE ADOPTION QUESTIONNAIRE

It is our policy to make certain that each person who adopts a dog is aware of the responsibilities of pet guardianship, and is capable of and willing to accept those responsibilities morally, physically and financially. Not every person who desires to adopt a dog should do so.

By completing this questionnaire, you will aid us in determining if you and your family are indeed ready for pet guardianship, and *if* the dog of your interest would suit you and your lifestyle. Should you agree that adopting a pet is a commitment throughout the lifetime of your companion animal, please fill out this questionnaire.

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PERSONAL INFORMATION

Names of all persons living in your household, their relationship to you and their ages:

Please list two personal references and their relationship to you:


YOUR HOME


YOUR PETS

Current Pet(s)

Cat, Dog (Breed) Age Sex Spay/Neutered? How & Why Obtained? How Long

Previous Dog(s)

Breed of Dog Age Sex Spay/Neutered?  Kept In or Out  What Happened?

 Fun Profit Show Accident

 Sit Down Come Stay Guard Attack Other

Your Family Veterinarian:

Phone:


YOUR NEW DOG

 Inside (where? )  Outside (where? )


 Yard Patio Run Balcony Unfenced yard Other


 Would not give up for any of the above

PLEASE READ AND INITIAL EACH STATEMENT BELOW:

  • I understand that a home visit is required prior to placement
  • I understand that a home check does not guarantee placement
  • I understand that any donation or contribution is a gift given in support of our rescue, not the purchase price of a dog. I will make a minimum tax deductible donation of $350 to help MPSR provide medical care, spay & neuter, boarding in support of our continuing rescue efforts of unwanted, abused & neglected dogs
  • I understand that if applying for a dogs in *Foster Care*, the Foster Parent may exercise their privilege to adopt
  • I understand my little dog may want to follow me around
  • I am familiar with the characteristics and temperament of this breed
  • I am prepared to pay someone up to $40, or more, every 4-6 wks to groom your pet
  • Adopters over the age of 70 are required to have a co-adopter in case of accident or death. If this applies to you, I will provide co-adopter? (must be present at time of adoption)
  • MPSR any of its representatives, reserve the right to refuse adoption to any applicant for any reason