Pet’s Name (from Website 0r Newspaper) OR Type of Pet you would like to adopt:
_________________________________________________________________
MOSTLY MUTTS, INC. ADOPTION APPLICATION
Mail to: Owner: Cheryl Hill, 284 Little Mountain Rd, Sunbury, PA 17801
OR E -MAIL TO: Foreverhomes284@aol.com
Today’s date: ___________
Name: ____________________________ DOB: __________ Age: ___
Address: _________________________________________________
City, State: _____________________________Zip:_______________
Home #:_____________ Cell #:_____________ Work #: __________
Drivers License #: _________________________ Exp: ____________
Email (print legibly): _______________________________________
A. General Information:
1. Are you adopting for: Self ___ Children ___ Gift ___ Other___________
2. Do you own/rent: House ___ Apt. ___ Condo ___ Town Home ___ Other________
a. Owners: Who pays the mortgage? I do___ Parents___ Other ________
b. Renters (required): Landlord _____________________ Phone_______________
3. Number of Adults _____ Roommates _____ Children (ages) _________________
a. Do you care for other children in your home? Yes No
4. How many times have you moved in the past five years? ____________
5. Is your yard completely fenced? _______ Partially fenced _____
a. Type of fencing _______________________________ Height ____________
6. Do you work Full time ____ Part time ____ Stay/work at home ____ In college ____
7. Have you ever been denied by another rescue? Yes___ No____ Explanation:
_________________________________________________________________________________________________________
B. Pet ownership:
1. Do you currently own other: Dogs #_____ Cats #_____ Other ________________
2. Are your pets current on vaccinations? Yes _____ No _____ Some are _______
3. Are your cats and dogs spay/neutered? Yes _____ No _____ Some are _______
4. Are you cats and dogs on heartworm preventative? Yes ____ No____
a. How often do you give preventative? Daily Monthly Every 6 months
5. Name and phone number of vet _____________________________________________
6. Have you ever completed a dog obedience course? Yes No
7. Have you ever surrendered an animal to a shelter? Yes No
8. List all companion animals you have owned in the past five years:
Name Breed Age Years owned? Where is it now?
______________ ______________ _____ ___________ ____________________
______________ ______________ _____ ___________ ____________________
______________ ______________ _____ ___________ ____________________
______________ ______________ _____ ___________ ____________________
______________ ______________ _____ ___________ ____________________
______________ ______________ _____ ___________ ____________________
C. YOUR NEW PET:
- How long have you been looking for a new pet? Not looking Days Months Years
2. Reason for adopting (circle): Watchdog Family pet Child’s pet
Hunting Gift Companion for other pet Other (describe) ___________________
3. Were your previous pets a) Inside_____ b) Outside____ c) Inside/outside___________
4. Where will your pet stay during the day (specifically):___________________________
5. Where will your pet sleep at night (specifically):________________________________
6. How many hours on an average work day will your pet be unattended? ____
7. Under what circumstances would you return this animal? (Please circle all that apply)
Bad decision, Aggression toward people, Aggression toward other pet, Moving,
Work schedule changes, Develops behavior problems, Barks, Poor health,
New baby in the family, Allergies, Divorce/Break up, Poor planning on my part,
Others: _____________________________________________________
8. If bad behaviors occur, how likely are you to hire a professional trainer?
Very Likely Likely Not Likely
9. How would you discipline bad behavior? ____________________________________
10. What will you do if you a) catch your dog pottying inside? ______________________
_____________________________________________________________________
b) if you don’t catch the dog but find it later?_________________________________
11. Are you prepared to care for a dog for up to 15 years? Yes No Can’t be sure
12. How much do you think routine vet care cost yearly? $___________
13. How much are you prepared to pay for emergency vet care? $___________
14. On a scale of 1-10 (10 being the best), what would your dog rate you? _______
15. What is your definition of a “RESPONSIBLE PET OWNER”?
Because we do not know you, we must check references (not optional).
Name of one Neighbor: ________________________________________
Phone: ___________________ Second phone: ________________
Name of Non-family member: ____________________ Relationship: _____________
Phone: ____________________ Second phone: ________________
ADOPTION FEES ARE AS FOLLOWS:
Over 60 lbs: FEMALES $125.00 MALES $110.00
Under 60 lbs “ $110.00 “ $100.00
YOUNG BREED SPECIFIC Puppy up to 5 years--No more than $200.00
MIXED BREED Puppies under 6 months $50.00
SENIORS aged 8 and over $75.00
(Puppies under (6) six months of age must be spayed or neutered at your expense at (6) six months of age and a contract signed stating that you agree to do this.)
Do you agree to a HOME VISIT? _______________________
Best time and day to set up visit? ________________________
Mostly Mutts, Inc. 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. Please read the following and sign below.
Mostly Mutts, Inc. has the right to refuse an adoption for ANY reason! The responsibility of Mostly Mutts, Inc. is in the best interest of the animal.
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, Inc. 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, Inc. Further, I agree to pay any reasonable expenses, including legal fees that may be incurred by Mostly Mutts, Inc. in the event that the adopted animal(s) placed into my custody are reclaimed by Mostly Mutts, Inc. b/c of neglect or abuse of said adopted animal(s). This application remains the property of Mostly Mutts, Inc. A fully executed contract completes this adoption.
Signature: __________________________________ Date: ____________________
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
For Mostly Mutts, Inc. use only: Approved Denied
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