Dog Adoption Request

Animal Interested In
Dog Name *
Applicant Information
First Name *
Last Name *
Address *
Apt / Unit #
City *
State *
Zip Code *
Cell Phone *
Home Phone
Drivers License / State ID # *
Email *
Confirm email
Are you employed? *
How long have you lived at this address? *
What type of home do you live in? *
If other, please explain.
Do you *
If other, please explain.
*IF YOU RENT, SOME LANDLORDS HAVE RESTRICTIONS FOR DOGS. PLEASE CHECK YOUR LEASE!*
Household Information
Tell us about the members of your household (adults, children, seniors).
Your current veterinarian's name
Do you have a yard? *
Is it completely fenced?
Have you ever owned a dog before? *
List all the pets you have owned in the last 5 years, alive or deceased
Pet #1
Name
Species / Breed
Age
Sex
Sterilized?
Alive?
If deceased, please explain.
Add another?
Pet #2
Name
Species / Breed
Age
Sex
Sterilized?
Alive?
If deceased, please explain.
Add another?
Pet #3
Name
Species / Breed
Age
Sex
Sterilized?
Alive?
If deceased, please explain.
Add another?
Pet #4
Name
Species / Breed
Age
Sex
Sterilized?
Alive?
If deceased, please explain.
Add another?
Pet #5
Name
Species / Breed
Age
Sex
Sterilized?
Alive?
If deceased, please explain.

I am adopting this dog for: *	Myself My Family My Children A Friend/Relative Companion for another pet
Who will be the primary caregiver of your new pet? *
Where will the dog be living and sleeping? *
If you had to move, what would you do with the dog? *
Any other information you would like to share?
Companion animals can live for 15-20 years, are you able to take on this commitment? *
Any other questions or concerns?
Addtional Information We will provide information on the new pet's medical and behavior history, as well as any tips on caring for them.
Please check any of the topics that you would like addtional information about.	Diet Crate Training Pet Proofing Home Introducing a new pet House Training Basic/Manners Training Finding a veterinarian Preventative care (fleas, etc) Grooming/Nail Trim Exercise/Toys Moving with pet
My signature certifies that the Michigan Anti-Cruelty Society (MACS) is authorized to gather whatever information MACS considers necessary and appropiate for adoption of any animal. MACS reserves the right to deny any adoptions.
Signature * Please sign.

Dog Adoption Request

Animal Interested In

Applicant Information

Household Information

Addtional Information