First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
Email*
Home Phone*
Work Phone x
Cell Phone
Alt Email
Which dog are you interested in? **ATTENTION!** If the dog you are applying for is not on this list, it means that dog is either not yet available or is no longer available. Unless specifically directed to do so, please do not randomly choose another dog from the list. Thank you! * Choose an animal: Daisy Dot Prince Rafferty Rosalina Steve
Please list all members of your household with gender and age (including yourself).*
Do you anticipate any children being added to the household in the near future?
Do you have other frequent visitors in your household? (family, friends, business clients, etc) If so, please note their ages, genders and frequency of visitation.*
How would you describe the activity level in your home? (ie busy/noisy with lots of daily visitors, usually quiet and calm, etc)*
Who in the household will care for the dog?*
If children reside in the home at what age do you feel children are responsible enough to take care of a dog without assistance? (i.e. walk, feed, etc.)*
Is every member of the household on board with bringing a new dog into the home?*
Is anyone in your house allergic to dogs? * Choose one: Yes No
If yes, how will you manage the allergies?
Why are you interested in adopting a pet at this time?*
Please list all other pets in the household with type of pet and breed, weight, gender and age.*
Do you have other frequent animal visitors in your home? If yes, please list their breed weight, gender, age, sex (altered or not altered).*
Are your current pets spayed/neutered? If no, is there a reason they are not?*
Are current pets up to date with basic vaccinations and preventatives? (for example, Distemper/Parvo vaccines, rabies vaccines, heartworm, flea and tick prevention). If no, please explain.*
Please provide your Veterinarian's Name and Phone Number where we can call to verify. (*please note, you will need to let them know it is OK to speak with one of our representatives)
Are you or your spouse employed?
If yes, please note the occupation, employer(s) and if it’s full or part time.
If your dog may need acute medical attention for an illness or emergency care, are you prepared to handle the expenses? * Choose one: Yes No
Where would your pet live if something were to happen to you?*
Will you keep an ID tag and collar on your pet?
Do you plan to license your pet with your town/municipality?
Is anyone home during the day? If so, who?*
Where will the dog be kept when you are home?*
How much time will the dog spend alone during the day?*
Where will the dog be kept when you are away from home? (i.e. crated, in a gated/separate room, free to roam)*
Where will the dog be kept if you travel or take an extended vacation?*
Where will the dog sleep?*
How do you plan on exercising your dog?*
What type and brand of food do you plan to feed your dog? (be specific)*
How many times per day do you plan to feed your dog?* Choose one: Once Twice Free feed (leave food out all the time)
Who in the home will be most responsible for feeding the dog?*
Describe what methods you will use to train your dog? If they require house training, for example, how would you train them?*
If your dog becomes destructive, what would you do?*
Are you aware that a dog may need some time to adjust to a new home and you may need to help them learn a new routine?
Have you ever had to give up a pet in the past? If so what was the reason and where did they go?*
Which of the following reasons would force you to return your dog to the rescue? (select all that apply)
If your dog has gotten out of your yard, what steps would you take to find him/her?
In what type of home do you live?* Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing
Do you own or rent your home?* Choose one: Rent Own
If you rent, how long have you lived there?
If you rent, have you received the approval of your landlord to have a dog? Choose one: Yes No
If you rent, please enter your landlord's name and phone number
Are there any breed or size restrictions where you live? (Including home owners policy restrictions). If so, please describe.*
Is your yard fenced?* Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced
If you have a partial fence, please explain...
What type of fence do you have?
What is the height of the fence?
Do you share a yard with other residents? If so, do they have pets or children?*
Do you have a pool?
Is there a fence around the pool that limits the dog's access?
Have you applied to any other Animal Rescues? If so, which ones?*
Please list two references (one family, one non-family) including phone number.*
How did you hear about us*
Would you like to add any comments?
I certify that the information entered on this application is true. Enter your name and date. *
Thank you for applying! ***PLEASE NOTE If your application has gone through, you should receive an acknowledgement e-mail from us that it has been received. If you DO NOT receive this email, please write to us at rescuemesadie@gmail.com so that we can verify your application came through. If you DO receive this email, your application should be in and a volunteer will get in touch within a couple days. **PLEASE BE AWARE THAT OUR FIRST COMMUNICATION WILL TYPICALLY COME FROM A VOLUNTEER VIA E-MAIL. SO BE SURE TO CHECK YOUR INCOMING MAIL, INCLUDING YOUR SPAM FOLDER**
