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Personal Information:
First Name _______________________ Last Name ______________________ Occupation_______________________
Do you have children? ___Yes ___No (If yes, please provide their names and ages)
Name __________________________
Age ________
Age _________
Have your children lived with or had exposure to dogs? ___Yes ___No
Residence Information:
___House ___Apartment
__
Fence Type ___
_____
Pet Information:
Dog #1
Name ________________________________ Breed _______________________________ Age________
Spayed or Neutered? ___Yes ___No
Dog # 2
Name ________________________________ Breed _______________________________ Age________
Spayed or Neutered? ___Yes ___No If no, please list
reasons:__________________________________________
Up-to-date on vaccinations? ___Yes ___ No
Dog #3
Name ________________________________ Breed _______________________________ Age________
Spayed or Neutered? ___Yes ___No If no, please list
reasons:__________________________________________
Up-to-date on vaccinations? ___Yes ___ No
Other Pet #4
Name ___________________
Age________
__ Species/Breed ____
______________
Other Pet #5
Name ________________
_______
______ Age________
How long are your dog(s) left alone during the day?
_______________________________________________________
Where do the dogs stay when youre not at home?
_______________________________________________________
Do you crate your dog(s)? ___Yes ___No
Past Pet Information: Please list any pets youve owned in the last 5 years (please include their
breed, name and age
__________________________________________________________________________________________________
Veterinarian Information:
Clinic Name____________________________
_________________________
Vets Name______________________________________
Phone # ________________________________
Reference #2
First Name _____________________________ Last Name ___________________________________
Home Phone _______________________
By signing this document I certify that all information provided on this application is truthful. I
give permission to Mighty Mutts Rescue, Inc. to verify information given if necessary, including
medical information from my Veterinarian. Any falsifying of information will terminate the
potential adoption. Mighty Mutts Rescue, Inc. reserves the right to deny adoption for any reason
without explanation. If approved this application becomes part of the adoption contract.
_________________________________
Signature
Date
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Signature
Date
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