Which pet(s) are you interested in adopting?

Your name

Address: City, State Zip:

Phone:

E-Mail:

Are you at least 18 years of age? No Yes

Are you a senior citizen (discounted adoption rate may apply)? Over 70

Would you allow a home visitation before adopting the pet? No Yes

What type of residence best describes your home? House Apartment Mobile Home Farm

Is this a rental property? no yes

If rental does your landlord accept pets? no yes

If so, up to what weight (in pounds):

Do you have a fenced yard? no yes

How many adults in your family?

How many children?

What ages?

Does anyone in family suffer from pet allergies? no yes

Any other pets? No Yes

Number of cats:

Number of dogs:

Are your pets neutered or spayed? No Yes

If you have cats, are they declawed? No Yes

Do they live inside? No Yes

Who is your current vet?

Have you had pets before? No Yes

What happened to them? (check all that apply)

Still with me/us.
Died -natural causes.
Died- accident.
Ran away.
Given away.
Lost.
Other. Please explain:

Will you keep your new pet:

Inside Outside Combination of inside/outside

How long will the pet be left on it's own each day? None (a family member is almost always home) 2 hours or less. 2-4 hours 4-6 hours 6-10 hours More than 10 hours

I would like to contribute:

Length of time at current residence:

Are all family members in agreement about obtaining a pet? Please explain:

Is this pet to be a gift or "surprise"? No Yes

If you chose yes above please explain:

Additional comments:

How did you hear about us?
MHS Website Petfinder Pets 911 1-800-Save-a-Pet A friend Other

Please confirm your Email Address:

Click the submit button once to send your application.

Click the reset button clear your application and start over.