Mississippi Animal Rescue League | Adoption Application

Applicant Information

Name (Required)

First Name

Middle Name

Last Name

Phone (Required)

Home Phone

Cell Phone

Address (Required)

Street Address

Apt #

City

State

Zip

County

Employer

Name

Dept.

Phone

How Long?

Street Address

City

State

Zip

Spouse

Name

Employer

How Long

Employer Address

Department

Phone

References

(Neighbor, Relative, or Friend)

Reference #1 (Required)

Name

Phone

Address

City

State

Zip

Reference #2 (Required)

Name

Phone

Address

City

State

Zip

Age

Which age group do you belong?:

Under 21

21 - 35

36 - 60

60+

Home Information

For Whom

Self

Family

Other Household Member

Other (Please specify)

Specify whom the pet is for

Kind of Pet

Dog

Puppy

Cat

Kitten

Reason

Specify reason for pet

Current Residence

Do you currently live in:

House

Condo

Apartment

Mobile Home

Complete Only If You Own

Do you live in a planned community

Mobile Home Park

Within City Limits

Describe restrictions, if any, which apply to owning a pet

Complete Only If You Rent

Do you lease by:

Year

Month

Week

Landlord's Name

Phone

Address

City

State

Zip

General

How many adults in your household?

How many children?

List ages of children

Are all members of your household aware of your plan to adopt a pet? Yes No

Is any member of your family allergic to animals? Yes No

Pet Information

Pet Experience

Do you have any dogs at home now? Yes No

Name	Age	Sex	Neutered/Spayed	Indoor	Stays In Fence	Chained	Outside Unconfined	Goes Out On Leash	Date of Last Shots	Heartworm Prevention	How Long Owned
		M F
		M F
		M F

Do you have any cats at home now? Yes No

Name	Age	Sex	Neutered/Spayed	Indoor Cat	Outdoor Cat	Date of Last Shots	Leukemia Vac	How Long Owned	Declawed
		M F
		M F
		M F

List any other pets other than dogs or cats

Do you plan to make any changes concerning your present pets when you bring the new pet home?

Please list any other dogs or cats you have owned in the last five (5) years and specify what happened to them

Name	Type of Animal	Age When Last Owned By You	Neutered/Spayed	What happened to this pet? Please be specific

Have you had a dog or cat die within the last three months of disease or unknown causes?

Yes No

Where any of your past or present pets adopted from MARL?

Yes No

List all pets adopted from MARL

Who is or will be your veterinarian?

Pet Care and Training

Choose whether you are interested in adopting a dog or cat

Dog/Puppy Cat/Kitten

How do you plan to housebreak your new puppy or dog?

How do you plan to handle chewing or other destructive behavior?

What will you do if your neighbors complain about your dog or puppy barking?

What type of heartworm prevention do you plan to use?

What do you plan to do if the dog or puppy you adopt test positive for heartworm?

How do you plan to handle scratching or other destructive behavior?

What will you do if your cat or kitten has an accident outside of the litter box?

Where will your pet stay in general? If outside, please describe yard and shelter.

Where will your pet stay when left alone?

On a typical day, how long will your pet be left alone?

What do you plan to do with your pet when you go out of town?

If you should move, what do you plan to do with your pet?

How do you plan to control ticks and fleas?

How do you plan to transport your pet? Be specific.

Are you prepared to assume the financial responsibilities of caring for a pet including veterinary care, feeding (approximate yearly financial obligations for a dog $250-350 fora cat $200-300)

Yes No

Adoption Application

Pet Adoption Application

Applicant Information

Name (Required)

Phone (Required)

Address (Required)

Employer

Spouse

References

Age

Home Information

For Whom

Kind of Pet

Reason

Current Residence

Complete Only If You Own

Complete Only If You Rent

General

Pet Information

Pet Experience

List any other pets other than dogs or cats

Do you plan to make any changes concerning your present pets when you bring the new pet home?

Please list any other dogs or cats you have owned in the last five (5) years and specify what happened to them

Have you had a dog or cat die within the last three months of disease or unknown causes?

Where any of your past or present pets adopted from MARL?

Who is or will be your veterinarian?

Pet Care and Training

How do you plan to housebreak your new puppy or dog?

How do you plan to handle chewing or other destructive behavior?

What will you do if your neighbors complain about your dog or puppy barking?

What type of heartworm prevention do you plan to use?

What do you plan to do if the dog or puppy you adopt test positive for heartworm?

How do you plan to handle scratching or other destructive behavior?

What will you do if your cat or kitten has an accident outside of the litter box?

Where will your pet stay in general? If outside, please describe yard and shelter.

Where will your pet stay when left alone?

On a typical day, how long will your pet be left alone?

What do you plan to do with your pet when you go out of town?

If you should move, what do you plan to do with your pet?

How do you plan to control ticks and fleas?

How do you plan to transport your pet? Be specific.

Are you prepared to assume the financial responsibilities of caring for a pet including veterinary care, feeding (approximate yearly financial obligations for a dog $250-350 fora cat $200-300)

What will yo do if you pet gets lost, stolen, or runs away?

What do you think you can do to help solve the problem of pet overpopulation?

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