Applicant's Full Name:

Applicant's Complete Home Address:

Applicant's Home Phone Number:

Best Time to Call:

Applicant's Email Address:

Name of Applicant's Veterinarian:
**If you do not currently have a pet/veterinarian**
**then list the name of any vets previously used**

Veterinarian's Address:

Veterinarian's Phone Number:

1. Is there a pet on our web site that you are interested in?  yes no
     If so, please specify:

2. Why do you want to bring a new pet into your home?

3. Is everyone in your household in agreement on adopting a pet?  yes no  

4. Do you have any pet(s) currently?  yes no  

**If you answered Yes to Question 4**
** Then please answer questions 4A and 4B**

4A. List type, breed, age, & sex.

4B. Are you sure your current pet will accept a new pet in the house?

5. Have you had other pets in the past?  yes no  

**If you answered Yes to Question 5**
** Then please answer questions 5A. through 5D**

5A. What type of pet(s) did you have in the past?

5B. How many years did you own the pet(s)?

5C. Reason for no longer owning the pet(s):

5D. If your last pet died what were the circumstances of his/her death?

6. Has any pet of yours ever gotten lost? yes no

6A. If yes, please provide explanation.

7. Has any pet of yours ever been poisoned? yes no

7A. If yes, please provide explanation.

8. Has any pet of yours ever been killed by a vehicle? yes no

8A. If yes, please provide explanation.

9. Would you allow a dog to ride loose in the bed of a truck? yes no

10. Would you leave a pet unattended in the yard? yes no

11. Do you have children at home? yes no

11A. If so, specify number and ages.

12. Do you live in a house, apartment, condominium, or trailer?

13. Do you rent, or own?

**NOTE** 
If you rent, you MUST have written permission from
your landlord stating that you are allowed to
keep a pet in the apartment.

14. Do you have a yard and is it completely fenced in?

15. If your yard is fenced, what type of fencing
       do you have and how tall is it?

16. Are you familiar with crate training?
       If applying for a dog, do you plan to crate train?

17. What provisions will be made for your pet
          if no one is home during the day?

17A. What provisions will be made for your
          pet when you go on vacation?

18. Specify if you have a gender and breed
       preference for the pet you want to adopt.

19. How long have you been looking for a pet?

20. Do any members of your household fear animals?   yes no  

20A. If yes, please specify details.

21. Will you assume all financial responsibilities for the
      pet you adopt, including inoculations, veterinary care,
      good quality food, licensing, etc.? yes no

22.Are you planning to change residence in the near future? yes no

22A. Please specify details.

23. Is anyone in your home allergic to animals?  yes no  

23A. If so, please specify details.

24. Are you familiar with the animal laws and regulations in your area?  yes no

25. Is the pet for which you are applying going to be a gift?  yes no

26. Do you understand that pets you adopt from Mutts-N-More
      must be spayed/neutered?  yes no

27.If Mutts-N-More recommends that you take obedience
      training classes with your pet, will you do so?  yes no

Please provide names and phone numbers of two pet-owning references
(neighbors, friends, etc.). Relatives MAY NOT be used as references.