Mostly Mutts Dog Adoption Form

Your First Name: *
Your Last Name: *
Your Age: *
Street Address: *
City: *
State: *
Zip Code: *
Best Number to reach you at: *
Email: *
How did you hear about Mostly Mutts? *
Pet Preferences:
All applicants - Please complete this section even if you have named a specific dog. This will help us with matching should the dogs you are interested in be unavailable or unsuitable.
Are you interested in a specific dog? *
Dog you are interested in: Leave field blank if you'd like us to help you make a match.
	Dog I am interested in is not listed
Dog Name/Description
If there is another dog you are interested in:
What size of pet are you interested in? You may choose more than one.
Age range preferred: You may choose more than one.
Energy levels preferred: You may choose more than one.
Your New Dog:
Are you adopting a pet to live: *
What will you do if you catch your dog pottying indoors? *
What will happen if your pet outlives you? *
How much are you prepared to pay for vet care? *
Tell us a little about yourself and why you feel you could provide a good home for this dog? *
Home and Family Information:
Are there any restrictions that we need to be aware of? *
Is your yard fenced? *
Are there other adults in the house? *
Are there children living/visiting your home? *
What is the age of the Children? You may choose more than one
On a scale of 1-5 (1=low, 5=high) rate your family’s energy/activity level: *
What is your work/home situation? * Choose One
If you work full time, but your new dog would be left unattended less than a full workday, please explain
How many hours, on average, will your new pet be left unattended per day? *
Pet Ownership:
How many dogs currently live in the home? *
How many cats currently live in the home? *
Are your animals currently spayed/neutered? *
Are your animals currently on heartworm preventative? *
Please contact your vet (s) to give permission to release your records to us. If your animals are seen by more than one vet please list them separately.
Name of Veterinarian (1)
Phone number of Veterinarian (1)
Name of pet OWNER the records would be under? (1)
Name of Veterinarian (2)
Phone number of Veterinarian (2)
Name of pet OWNER the records would be under? (2)
Have you ever surrendered an animal to a shelter or animal control or given a pet away in the last 2 years? *
Personal References:
Please contact your references to let them know to expect a call from us. NOTE: the call will be from an unfamiliar number-not Mostly Mutts.
Reference Name (1) *
Relationship *
Best Contact # *
Reference Name (2) *
Relationship *
Best Contact # *
PLEASE READ THE FOLLOWING AND SIGN BELOW. Mostly Mutts appreciates your patience and understanding throughout this application procedure. Please understand our goal is to make sure these animals are placed in only the best homes. The responsibility of Mostly Mutts is the best interest of the animal. Mostly Mutts has permission to contact my vet, landlord & references during the application process. Mostly Mutts has the right to refuse any adoption for ANY reason. This application remains the property of Mostly Mutts. A fully executed contract completes this adoption. I certify that the above information is true. I understand and agree that this adoption placement is conducted solely for the purpose of providing long-term care for the adopted animal(s). Should a representative of Mostly Mutts ask to see the animal(s), reasonable access will be granted. If it is determined that the animal(s) are not properly cared for, the animal(s) may be reclaimed by Mostly Mutts. Further, I agree to pay any reasonable expenses, including legal fees that may be incurred by Mostly Mutts in the event that the adopted animal(s) placed into my custody are reclaimed by Mostly Mutts because of neglect or abuse of said adopted animal(s).
Applicant's Signature *
Date

Mostly Mutts Dog Adoption Form

Pet Preferences:

Your New Dog:

Home and Family Information:

Pet Ownership:

Personal References: