MOBERLY ANIMAL SHELTER ADOPTION APPLICATION

I agree to reply to email communication in a timely manner and understand if a reply is not received by the shelter within 48 hours the shelter will move forward with other applicants, however my application will be kept on file for future use. Please add our email to your safe senders list. *

Animal You are interested in Adopting *

Applicant's First Name *

Applicant's Last Name *

Street Address *

City *

State *

Zip Code *

Cell Phone *

Home Phone *

Email Address *

How long have you lived at this address? *

If less than 3 years, list all addresses for the past 3 years with dates.

Do you rent or own your home? *

If you rent, enter the name address, and phone number of your landlord

If you rent, does your landlord and lease allow pets?

Does anyone in your household have allergies to dogs/cats? *

Is everyone in your household aware of and ok with the fact that you wish to adopt a dog? *

Including yourself, how many people live in your household? *

Please select your current residence type. *

Please list the ages and relationship of those who live in your home. *

What would you do with your animal if you had to move? *

Employment status. *

Current Employer/Occupation *

If and when your family encounters a life-changing event, such as moving, marriage, having a baby, death in the immediate family, would you keep your dog? *

Are you willing to take responsibility for this animal for the next 10-20 years? *

What arrangements will you make for the care of your pets in case of emergency? *

If you answered "other" above please explain here:

What will you do with the animal when you go on vacation? *

If you answered "other" above, please explain:

For what reason(s) would you consider returning/giving up or re-homing the animal? What would you do with him/her? *

On average, how many hours per day will your pet be left alone? *

Do you have a completely fenced yard? If so, what kind of fence? *

If you do not have a fenced yard, how will you let the animal out? *

Are there times when the animal will be tied/chained up? *

If yes, when will they be tied/chained up?

Are you willing and able to exercise the dog on a regular basis? *

If yes, what is the method of exercise? *

Please provide a description of this pet's living conditions. *

Will this pet be predominately living inside, outside, or both? *

Where will the animal sleep? *

How will you handle housebreaking? *

How will you handle destructive behavior? *

Do you own other pets at this time? *

If yes, please list their names, breeds, and ages.

Is your pet listed under another name at the vet than the one above *

Are all of your pets spayed/neutered/fixed? *

If no, please explain:

Are your pets current on their vaccines? *

If no, please explain:

Have you ever had a pet euthanized? *

If yes, please explain?

How many pets have you owned in the last 5-10 years? *

What happened to them? *

Veterinarian's Name (List all Vets you have used in the past) *

Veterinarians Address, City, State and Zip Code. *

Veterinarian's Phone Number (Please list all) *

Please check the Main Reason you plan to adopt a pet. *

If you answered "other" above, please explain: *

Will you keep the animal up to date on vaccinations and heartworm preventative? *

Have you applied anywhere else for a pet? *

If yes, Where else have you applied for a pet?

Are you familiar with heartworm and heartworm prevention? *

Why do you wish to adopt and what makes this dog a good fit for your family? *

Have you ever relinquished, given away or re-homed a pet to a shelter, rescue, family or individual *

If yes, please explain

I certify that I am 18 years of age and that all information provided on this form is true. I give permission to the shelter to verify information as needed. Any false statement will terminate potential adoption. If at any time I can no longer keep my adopted pet, I will contact the shelter and request help in finding a new home for my pet, there is no guarantee that the animal can be returned to the shelter, but every effort will be made to help in finding a new home. I understand the sole purpose of this application is to find right placement and a lifetime, loving home for Moberly Animal Shelter Dogs. The best interest of our dogs takes precedence over all other factors. I agree and understand the adoption fee will be used towards other animals to be spayed or neutered that will be up for adoption. All funds from the adoption fees will be used by the Moberly Animal Shelter to help with food, veterinary care and other supplies for animals at the shelter. *

I will provide humane care, giving the animal proper food, water, shelter and exercise. I will not allow anyone to treat the animal with cruelty, nor will I allow the animal to be used for experimental purposes, dog fighting, dog fighting bait or any other form of animal cruelty. I will provide the animal proper care with a competent veterinarian in case of injury or illness and I will have a licensed veterinarian administer all currently recommended vaccines and preventatives, all at my expense. I will not sell, give away or abandon the animal. I assume all ownership of the animal and release the City of Moberly and the Moberly Animal Shelter for any and all liability for any illness of the animal and for any damage on injury in which the animal my cause to any person or property. I furthermore agree to continue all necessary treatment until the dog is healthy. I understand that this application does not guarantee that I will be approved to recei *