First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
 - 

Email*

Home Phone

Work Phone
x

Cell Phone*

Are you at least 18 years old?*
Choose one: Yes No

Do you own or rent your home*
Choose one: Rent Own

How long have you lived here?*

In what type of home do you live*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

If you rent, please enter your landlord's name and phone number

If you rent, have you received the approval of your landlord to have an animal
Choose one: Yes No

Is your yard fenced*
Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced

If you do have a fence, please describe; height, material, approximate size of enclosure.

Which animal are you interested in
Choose an animal: Chloe

What is your timeframe for adopting?*
Choose one: Ready and eager for a dog this week; actively looking at shelters and surfing the internet. Applying to multiple rescues; hoping for the right match in the next few weeks. Happy to wait a few months for the right fit. I am only applying for one specific dog, and if I don't get him/her I will look no further.

Who will be responsible for the daily care of this dog?

How much time will the animal spend alone during the day*

How will you keep the dog confined to your property? (check all that apply)

How many times a day are you willing to exercise your dog? And what type of exercise?

Dogs often live longer than 10 years and some can live into their late teens. Are you willing to make a long term commitment to your dog?

What will you do if your dog shows destructive behavior (digging, chewing, jumping, or running off)?*

You may have to housebreak your dog. Are you willing to do that?

How long will you give this dog time to adjust to its new home?

If there are young children in the home, they need to be educated on how to interact with the dog in order to prevent dog bites. Are you able and willing to do that?

What forms of training will you provide for your dog? (Check all that apply)

How many adults are in your household? How many children? And their ages?*

Do all the members of the household WANT this dog?

If no, explain why.

Please provide a list of Current Pets in your household: Include type (dog, cat or ?), Spayed or neutered, Indoors or outdoors, time owned and their age.*

Please provide a pets your Previously Owned. Include type, spay/neuter, indoor/outdoors, time owned and what happened to them.*

Veterinarian's Name and Phone Number. How long have you used this vet?*

Are you familiar with heartworm disease? And will you maintain your dog on heartworm preventive medication?

Have you adopted or fostered a dog or any other animal with FMCMA before?

If yes to adopted or foster before, when and where is the dog or animal now?

I understand the sole purpose of this application is to find a lifetime, loving home for dogs that are available for adoption through FMCMA. The best interest of the dog takes precedence over all other factors.*

Do you acknowledge that there is an adoption fee of $200 and you agree to pay that fee prior to receiving the dog you are adopting?*

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 Friends of Macon County Missouri Animals (FMCMA) from any and all liability for any illness of the animal and for any damage or injury in which the animal may 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 receive approval for adoption.*

I certify that I am 18 years of age, and that all information provided on this form is true. I give permission to Friends of Macon County Missouri Animals (FMCMA) 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 FMCMA and request help in finding a new home for my pet. I am aware that there is no guarantee that the animal can be returned to FMCMA, but every effort will be made to help in finding a new home. Please enter your name and today's date.*