Manitoba Mutts Dog Rescue

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When supplying references please DO NOT uses family members as a reference

In order to be considered for an adoption you must: 1) be 18 years of age, 2) have the knowledge and consent of all adults living in your household, 3) understand that completing this application does not guarantee adoption, and that the Manitoba Mutts Rescue must approve your application, 4) If you are not approved for a specific dog / cat we encourage you to apply for another dog / cat that may better suit your lifestyle.

ADOPTION APPLICATION FORM

Name of Dog/Cat Application is for

Adopting

Application Date

APPLICANT INFORMATION

Name

Occupation Status

Address

City

Postal Code

Email Address #1

Email Address #2

Phone Number #1

Phone Number #2

Phone Number #3

Do you live in a

Do you

Landlords Name

Landlords Phone Number

Landlords Address

How Long at Current Address

If less than 1 year please list previous address and how long there

GENERAL INFORMATION

Number of Adults

Number of Children

Ages of Children

Who will be primarily responsible for the care (feeding, grooming, exercise and training) of your new pet?

Why adopt

How many pets do you have now?

Dogs

Cats

Other

Name

Type/Breed

Age

Sex

Spayed/Neutered?

Where you got the pet from

Have you ever fostered for or adopted from another rescue? If so, which one?

What veterinarian would have records (past/present)?

What veterinarian do you plan to use?

Have you ever needed to return or re-home a dog/cat? If so why?

Have you ever euthanized a dog?

If yes, why?

Do you or any family members suffer from pet allergies?

Do you have plans to move in the near future?

If at some point you do move, what will you do with your pet?

How much time will this dog/cat be alone (without human companionship)

Hours/Day

Days/Week

Where will the dog/cat be kept when home alone?

Where will the dog/cat sleep?

How/where will the dog/cat receive exercise

How Often?

Do you have a fully fenced yard?

If yes, how high is it?

When, or if not fenced, will you use a leash

How will you discipline or correct your dog/cat?

A dog/cat can live well over 10 years and requires a major commitment of time, finances and emotion. Why do you feel you can make that kind of commitment at this time?

Weight/size of dog, as an adult, you are looking for?

While we do our best to disclose any behavioural problems that we are aware of, do you understand that rescued dogs may have a history of behavioural problems which we are unaware of? If undesired behaviours appear, are you willing to work with them? Please describe what behaviours and training you are and/or are not willing to work with.

REFERENCES

Reference #1

Name

Relationship

Contact Number

Best time to contact

Reference #2

Name

Relationship

Contact Number

Best time to call

Reference #3

Name

Relationship

Contact Number

Best time to call

ADDITIONAL INFORMATION

How did you hear about us?

Do you know anyone who has adopted from us?

Additional Information

Security Code

Verified

By submitting this form, I certify that the information given is true and correct and I recognize that any misrepresentation of facts will result in my losing the privilege of adopting a pet. I also give my veterinarian permission to release any vet care records and information about my current and past pets to the MMDR I understand that this application is the property of the MMDR and that the MMDR has the right to deny my request to adopt.

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