Middleburg Heights Animal Foundation

Adoption Application for Dogs & Puppies

Today's Date:

Full Name:

Street Address:

City, State, Zip Code:

E-mail:

Phone Number:

Best Time to Call:

Name of pet you are interested in adopting:

What do you like about this specific pet?

How many adults are in your household?

How many children are in your household?

Please list the ages of the children in your household:

Other frequent visitors

Do you currently have any pets?
  Yes
  No

If you answered yes above, please explain?

Please list all of the animals that you have owned in the past 10 years. Be sure to include type / breed of pet, age, sex, if the pet was spayed / neutered, if yearly vaccinations /heartworm were received, and where the pet is now.

I have owned a dog before:
  Yes
  No

The last time I had a dog was:

How many hours will your dog spend outside per day?

My dog needs to be able to be alone:
  2 hours or less per day
  4 hours or less per day
  8-10 hours per day
  12 hours per day

When I'm at home I want my dog to be by my side:
  All of the time
  Some of the time
  Little of the time

I want a guard dog:
  Yes
  No

I want my dog to hunt or herd with me:
  Yes
  No

I want my dog to be the type that is very enthusiastic in the way s/he shows love to people:
  Not at all
  Somewhat
  Very

I want my dog to be playful:
  Not at all
  Somewhat
  Very

I want my dog to be laid back:
  Not at all
  Somewhat
  Very

I am comfortable doing some training with my dog to improve manners such as jumping, stealing food, and pulling on the leash:
  No training
  Some training
  A lot of training

I (or my child/ren) want to participate in Agility, Flyball, or Obedience with our dog:
  Yes
  No

I am interested in a dog with "special needs" (medical or behavioral):
  Yes
  No

The most important thing for me is that my dog

Activities you may want to do with this dog (jogging, hiking, camping, leisure walks, swimming, long road trips, etc.):

How will you contain your dog in the yard?

How will you exercise your dog?

Do you currently...?
  Own
  Rent
If renting, please provide the following...
Landlord's Name:

Landlord's Phone Number:

Are you planning any major life changes in the next 5 years (marriage, moving, pregnancy, etc.)?

Is any member of your household allergic to pets?
  Yes
  No
If yes, what type of allergies?

Are there any reasons why you would give up a pet?

Are there behaviors that you would have a hard time dealing with? How would you handle these problems?

Tell us about the personality traits you desire in your dog (this especially helps us find a good match for our adult dogs)

Please understand, there are many times when a home visit is required before the adoption of this pet. Do you agree to a home visit?
  Yes
  No

If not, please explain.

Where will your pet be...
When you are gone from home?

When you are sleeping?

What would happen to your pet(s) if you could not keep them or care for them?

Are you familiar with the necessary and potential medical care this dog may require now and in the future; such as annual check-ups, Heartworm prevention, vaccinations, etc.?
  Yes
  No

Any additional information you would like us to consider in reviewing your application. If you want us to hold this pet for any additional amount of time, etc. please indicate so here.

Who is your family veterinarian or veterinary clinic?

Vet's Phone Number:

How did you hear about MHAF?

I, the undersigned, do hereby release Middleburg Heights Animal Foundation, its directors, officers, trustees, volunteers and representatives from liability to myself and/or my party for any damage, accident, or injury to person(s) or property incurred in relation to viewing of the animals under the control of the organization.

I hearby affirm that all of the above information is true and correct. I understand that submission of this application does not necessarily mean that I will be approved to adopt and Middleburg Heights Animal Foundation reserves the right to reject any applicant. I authorize MHAF to verify any and all information set forth in this application. (Without your electronic signature we cannot process this application).

Signature: Date:

By typing your name in the signature box above you certify that the information included in this application is true and accurate to the best of your knowledge and that you are the individual requesting to be approved for the adoption of a pet currently in the care of Middleburg Heights Animal Foundation and its foster homes.