Adoption Application

Contact Information

First Name

Last Name

Email Address

Phone Number

Text?

Yes

No

2nd Phone Number

Text?

Yes

No

Address

City

State

Zip Code

Occupation

Animal Interested in Adopting

Name

Animals in Household

How many adults are in your home?

How many children are in your home and what are their ages?

If so, what are the children's' ages?

What type of home? (House, Apartment, etc.)

Do you rent or own?

If you rent, do you have permission of the landlord to have a pet and are able to pay a pet deposit if the landlord requires?

Have you ever had parvo in your home/yard?

If yes, how long ago was this?

Does anyone in the family have known allergies to dogs?

Yes

No

If you decide to move to a smaller home or have to move out of town, will you take your new pet with you?

Yes

No

Is everyone in agreement with the decision to adopt a pet?

Yes

No

Are you prepared to love and care for this dog throughout its life, no matter what life changes are put before you? (Job change, divorce, new pets, new baby, etc.)

Yes

No

Do you have time to provide adequate love and attention?

Yes

No

What other pets do you have? (Please specify type, age, male/female)

Are all of your pets spayed or neutered? If not, why?

Are all of your pets current on vaccines? If not, why?

Have you ever given away a pet?

Yes

No

If yes, why?

Have you ever had a pet euthanized (put to sleep)?

Yes

No

If yes, why?

Has a pet of yours ever gone missing?

Yes

No

If yes, how and did you get it back?

Where will you keep the dog?

If outside only, what kind of shelter will the dog have?

What type of fence do you have?

How tall is your fence?

Do you agree to return the dog to us if you can no longer keep it?

Yes

No

This is a requirement! The city shelter is NOT an option.

Are you willing to let a represenative of MASA visit your home by appointment?

Yes

No

MASA is a foster based rescue. Each and every one of our animals live in a foster/temporary home until it gets adopted. The more foster homes we have, the more animals we save!

Would you be interested in being a foster home?

Yes

No

Maybe

How did you hear about us?

Veterinarian

Do you agree to provide regular health care by a license veterinarian?

Yes

No

Do you currently have a regular veterinarian?

Yes

No

Veterinarian's Name

Veterinarian's Phone Number

If you don't already have a veterinarian we can give you some recommendations.

Personal Reference

This should be someone who will vouch for you and/or someone we could contact if we are unable to get ahold of you.

Personal Reference Name

Phone Number

Address

City

State

Zip Code

Relationship

Agreement

***To adopt, you must be at least 18 years old, have the knowledge and consent of all adults living in your home, and be willing and able to spend the time/money needed to provide the dog with training, vet treatment, and proper care. We reserve the right to approve or deny any adoption. Every MASA animal has been vetted and cleared for adoption by a licensed Veterinarian. This does not guarantee that every animal is 100% healthy as conditions may show up after adoption and MASA is not responsible for any further veterinarian bills, unless otherwise agreed. MASA is not responsible if the animal you adopt bites another animal or human. Proper introduction, training, discipline, and exercise can help avoid bad behaviors. If you decide that you can no longer provide a home for this animal you are required to release it back to MASA. ***Adoption fees are considered donations are nonrefundable and non-transferrable.***

***For adopters in the Pacific Northwest – With direct adopt, you are getting the dog, sight unseen. If for any reason it's not working out, we ask that you notify MASA immediately. We ask that you keep the dog safe and secure either at your home or in boarding, at adopter expense, until either re-homed through Project Freedom Ride & MASA's process, transferred to one of our receiving partners in your area, or transported back to MASA via the next available transport. If it comes to transporting back to Texas, MASA would absorb that expense. We ask that you allow us 30 days to sort everything out.

***I agree to keep proper ID tags on the dog.

***If the dog is ever lost, stolen, or dies, I agree to notify MASA.

***I agree to allow a MASA representative to contact me by phone, text, or email for updates on the dog.

***If I move or change my phone number I will contact MASA to update my information.

***I agree to allow MASA to post my adoption picture to its Facebook page and/or website.

***I understand that the microchip will stay registered to MASA’s name for the life of the dog. I, the adopter, will be added to the registry.

All the information I have given is true and complete. This dog will reside in my home as a pet. I will provide quality dog food, plenty of fresh water, indoor/outdoor shelter, affection, annual physical examination and vaccinations under the supervision of a licensed Veterinarian.

Terms

I agree to the terms listed.

I do not agree to the terms listed.

Signature

Date

Until there are none... Rescue One.

Contact Information

Animal Interested in Adopting