MPMR APPLICATION TO ADOPT/FOSTER

MPMR APPLICATION TO ADOPT/FOSTER
Are you applying to adopt or foster:
Which dog are you applying to adopt?
Applicant Personal Information (NOTE: Applicant must be at least 21 years of age)
First and Last Name
Age
Address
City
State
Zip
Home Phone
Cell Phone
E-mail
Employer
Position
Work Phone
Co-applicant Personal Information (NOTE: Co-applicant must be at least 18 years of age)
Name
Age
Address
City
State
Zip
Home Phone
Cell Phone
E-mail
Employer
Position
Work Phone
Characteristics of the dog you hope to adopt/foster
Gender

No PreferenceMale PreferredMale RequiredFemale PreferredFemale Required
Color

No PreferenceBlack & TanChocolateRedBlueFawn
Age

No PreferenceUnder 11-2 years3-4 yearsOver 5 years
Energy Level:

No PreferenceHigh—requires plenty of exercise daily like jogging, dog–dog playModerate—requires at least two walks daily, plus some play indoors or in a fenced yardCouch potato—this level of dog is happy with a couple of leisurely strolls or visits to a fenced yard daily
Pet Care Experience
Have you ever owned a dog before?

YesNo
If yes, as an

AdultChild
Have you ever crate trained a dog before?

YesNo
If yes, as an

AdultChild
Have you ever housetrained a dog before?

YesNo
If yes, as an

AdultChild
Have you ever obedience trained a dog before?

YesNo
If yes, as an

AdultChild
If you ever had a pet die due to an accident, please give details:
Please list ALL pets (not just dogs) that you have owned in the past 10 years. Include: Name/ type, sex, age, spayed or neutered, present location (current, or note deceased.
Household Information
Who lives in your house?
Dog(s)
Cat(s)
Other (please specify)
List the residents of your household (other than applicant and co-applicant). Include names and ages:
If the above named are children, what is their experience with dogs?

FrequentSomeNone
Lived with

Large dogSmall dog
Are you currently expecting a child?

YesNo
Are you considering having children within 10 years?

YesNo
Please explain how you resolve issues relating to new children and your dog:
If you have children, how do you prepare your children for the addition of a dog to their family?
Type of dwelling:

HouseTownhouseApartmentCondoDuplexMobile Home
Do you

OwnRent
If you rent, have you received permission from your landlord to have a dog?

YesNo
If you rent, is there a weight limit on dogs?

YesNo
Landlord contact information
Dog Ownership
Why do you want a dog?

CompanionGuard dogGiftPersonal protectionFor childOther
Have you considered the full ramifications of taking a dog for the rest of its life—through illnesses and old age?

YesNo
Have you considered that over time a dog may require changes to your life including (a) providing your dog with more frequent opportunities to eliminate; (b) providing your dog with more padding in his/her bedding as old age sets in; or (c) adjusting your routine to allow your dog to avoid stairs later in life?

YesNo
General Questions
Estimate the cost to take care of your dog each year (food, vet care, license, toys, supplies, training): $
Do you currently have a veterinarian?

YesNo
Vet's Name
Practice Name
Phone
Plans for crate use:

No crateReluctant to crateCrate if necessaryTemporarilyPermanently
Is anyone home during the day?

YesNo
If yes, who?
Where will the dog be kept when no one is home? (please be specific)
How many hours a day will the dog be left alone?
Where will the dog sleep at night? (please be specific)
Applicant: Average number of days you are out of town (business or pleasure)

01-34-6>6
Average number of days you are out of town (business or pleasure)

Per weekPer monthPer year
Co-Applicant: Average number of days you are out of town (business or pleasure)

01-34-6>6
Average number of days you are out of town (business or pleasure):

Per weekPer monthPer year
How will your dog be cared for when the responsible persons are out of town?
How do you plan to exercise your dog?
Do you live near a dog park?

YesNo
If yes, would you use it for your dog?

YesNo
Do you or any member of your household plan to run/jog with your dog for aerobic exercise?

YesNo
How will all of your dog’s outdoor activities be supervised?
Is your yard fenced?

YesNo
If yes, what kind of fence? (height and material)
If you move, what will you do with your pet?
Additional questions or comments at this point?
How did you hear about Min Pins and More Rescue?

Previous adopterPersonal recommendation from friend or familyFacebookAdopt A PetPetfinderWeb searchSaw a flyer postedOther
References

Please list two references. (Neighbors, Vets, MPMR Rescue volunteers, etc.).
Reference 1: Name
Relationship
Phone
Reference 2: Name
Relationship
Phone
Thank you for your interest in adopting/fostering a dog from MPMR. An Adoption/Volunteer Coordinator will contact you for an interview within two weeks of receipt. If you have not heard from us at that time or have questions about the process, please contact us at equisetteracres@yahoo.com.

I represent that all information on this form is true and correct to the best of my knowledge. I understand that any misrepresentation of fact may result
in the removal of the adopted/fostered dog from my home by MPMR, inc.
Applicant Signature
Date
Co-applicant Signature
Date
Should be Empty:

MPMR APPLICATION TO ADOPT/FOSTER

Applicant Personal Information (NOTE: Applicant must be at least 21 years of age)

Co-applicant Personal Information (NOTE: Co-applicant must be at least 18 years of age)

Characteristics of the dog you hope to adopt/foster

Pet Care Experience

Household Information

Dog Ownership

General Questions

References