Adoption Application Submissions

This questionnaire is designed to help Midnight Run Rescue and yourself determine if a specific dog is the right one for you and your household. All adopting parties are required to complete this form prior to adoption. Midnight Run Rescue reserves the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoptions!

Name of the dog you are interested in:

Your full name:

Your age:

Street Address:

City, State, Zip

Home Phone:

Area CodePhone Number

Cell Phone:

Area CodePhone Number

E-mail:

Personal character reference and phone number:

Are all members of your household in agreement with this adoption?

Who will be the pet's primary caregiver?

Do you own or rent?

If rent, provide name and phone number of landlord:

Does your landlord allow dogs?

Do you have a fully fenced yard?

Height and type of fence

Do you have any of the following?

How many adults are in your household?

How many children are in your household?

If children, what are their ages?

Have your children been around animals before?

Does anyone in your home have allergies to dogs or have asthma?

List any pets you own or have owned in the past five years, and their ages

Are these animals up to date on vaccinations & heart worm preventative?

Are they fixed?

Have you adopted from an animal welfare group before?

If yes, what group?

Have you ever given up a pet?

If yes, what were the circumstances?

Please provide the name and phone number of your current and/or previous veterinarian or clinic:

What type of personality do you want your pet to have? (i.e. calm, energetic, protective, couch-potato)

Are you aware of crate training?

Have you ever house-broken a dog or puppy before?

If the dog has an "accident" in your home, what type of correction do you plan to use?

How many hours each day will your new pet be home alone?

Where will your new pet sleep at night?

Where will your new dog stay when nobody is home?

What length of time will you allow your new pet to adjust to his new home?

Are you financially and emotionally prepared for a new member to join your family and household?

If you had to give up your dog, what would you do with him/her?

I understand that I assume full responsibility for the welfare of this pet from the date of adoption.

Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information