Adoption Application

Maumelle Animal Services

Pet Name (please select):
If pet not listed, please type it here:
Applicant First/Middle Name: *
Applicant Last Name: *
Street Address: *
City: *
State: *
Zip: *
Primary Phone: *
Other Phone:
Email Address: *
Driver's License Number: *
Date of Birth: *
Adults (over 18) in the home (name, age): *
Children in the home (name, ages):
Do all in home want to adopt this animal? *
Why do you want this animal? *
Is it a gift for someone? *
Have you ever adopted an animal from MAS before? *
Do you still have the adopted animal? *
What happened to the animal? *
Your residence is (select one): *
Do you own or rent your home? * Do you own or rent your home?
Name of complex: *
Landlord Name & Phone Number: *
How long have you been at your present address? *
Are you moving soon?
Who would be the primary caretaker of this animal? *
Is this person over the age of 21? *
Anyone at home have allergies that would be affacted?
Where would this animal be kept during the day? *
Where would this animal be kept during the night? *
How many hours would this animal be left alone during the week? *
How many hours would this animal be left alone during the weekend? *
Where would this animal be during vacations or business trips? *
Please list all current pets in household (Name, Age): *
Please list past pets and what happened to the animal(s): *
Are all current pets current on shots?
Are all current pets on Flea/Tick Preventative?
Are all current dogs on Heartworm Preventative?
Provide your current veterinary clinic contact information (Name & Phone Number):
Past Animal Clinic(s):
Animals choose when and how to relate to you. Some are aloof and will come to you for affection only when they please, other animals want attention constantly. Are you prepared to respect your animal(s) unique personality? *
What means of discipline would you use on this animal? (Jumping, scratching, etc) *
Are you willing to put up with animal hair in your home? (they all shed!) *
Are you willing to keep litter boxes or kennels in your home, scoop waste daily and change bedding regularly? *
Would this animal (if cat) be declawed?
What would make you consider declawing?
General, non-emergency medical care averages $400 for a healthy animal per year, NOT including food, toys, litter, etc. Have you considered, willing and able to pay expenses of yearly shots, food, toys, routine care and possibly emergency medical services for this animal for the next 15-20 years? *
You will be sharing your life with an animal for 15-20 years, whom is 100% dependent on you. Are you willing to make a lifelong commitment to care for this animal for the rest of its natural life? *
Are you willing for a representative of MAS to make one or more random house visits, if warranted by concerns of the person following up on the adoption, in order to ascertain that this application was answered truthfully and that the terms of the contract are being adhered to? *
I understand this adoption is not final until MAS' adoption contract has been signed by both parties to the adoption (applicant & MAS Rep) I, the undersigned, under penalty of law, certify and affirm the information contained herein is true and correct, and that I am not less than 21 years of age. *

Check all entries for accuracy, then press the "Submit" button ONLY ONCE. You will be returned to our website.
Please note we are unable to process incomplete applications.